How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $5.75 Median $10.23 Typical High $12.02 | Facility | None | $5.75 | $10.23 | $12.02 |
Aetna Setting Professional Modifier None Typical Low $10.23 Median $10.23 Typical High $12.02 | Professional | None | $10.23 | $10.23 | $12.02 |
Anthem BCBS Setting Facility Modifier None Typical Low $20.42 Median $20.42 Typical High $40.74 | Facility | None | $20.42 | $20.42 | $40.74 |
Anthem BCBS Setting Professional Modifier None Typical Low $6.46 Median $7.59 Typical High $8.51 | Professional | None | $6.46 | $7.59 | $8.51 |
CDPHP Setting Professional Modifier None Typical Low $16.60 Median $16.60 Typical High $16.60 | Professional | None | $16.60 | $16.60 | $16.60 |
Cigna Setting Facility Modifier None Typical Low $36.31 Median $36.31 Typical High $36.31 | Facility | None | $36.31 | $36.31 | $36.31 |
Cigna Setting Professional Modifier None Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | None | $9.55 | $9.55 | $9.55 |
Emblem Health Setting Facility Modifier None Typical Low $20.42 Median $33.88 Typical High $74.13 | Facility | None | $20.42 | $33.88 | $74.13 |
Emblem Health Setting Professional Modifier None Typical Low $22.39 Median $22.39 Typical High $29.51 | Professional | None | $22.39 | $22.39 | $29.51 |
Excellus BCBS Setting Professional Modifier None Typical Low $11.48 Median $11.48 Typical High $11.48 | Professional | None | $11.48 | $11.48 | $11.48 |
MVP Health Care Setting Professional Modifier None Typical Low $12.02 Median $12.02 Typical High $26.30 | Professional | None | $12.02 | $12.02 | $26.30 |
United Setting Facility Modifier None Typical Low $26.92 Median $26.92 Typical High $34.67 | Facility | None | $26.92 | $26.92 | $34.67 |
United Setting Professional Modifier None Typical Low $9.77 Median $12.30 Typical High $16.98 | Professional | None | $9.77 | $12.30 | $16.98 |
Univera Setting Facility Modifier None Typical Low $12.59 Median $20.42 Typical High $20.42 | Facility | None | $12.59 | $20.42 | $20.42 |
Univera Setting Professional Modifier None Typical Low $11.48 Median $11.48 Typical High $17.38 | Professional | None | $11.48 | $11.48 | $17.38 |
5 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $5.13 Median $5.13 Typical High $6.03 | Professional | 52 · Reduced service | $5.13 | $5.13 | $6.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.04 Median $2.04 Typical High $2.40 | Professional | 53 · Discontinued | $2.04 | $2.04 | $2.40 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.55 Median $1.55 Typical High $1.82 | Professional | 55 · Aftercare only | $1.55 | $1.55 | $1.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.02 Median $1.02 Typical High $1.20 | Professional | 56 · Pre-op care only | $1.02 | $1.02 | $1.20 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $13.80 Median $16.22 Typical High $19.95 | Professional | UE · Used equipment | $13.80 | $16.22 | $19.95 |
Where New York sits
The same service costs 3.0 times more in Montana than in New York. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
New York· 51st of 51
$8.51
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.