How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $5.25 Median $5.25 Typical High $5.25 | Facility | None | $5.25 | $5.25 | $5.25 |
Aetna Setting Professional Modifier None Typical Low $3.98 Median $5.25 Typical High $5.37 | Professional | None | $3.98 | $5.25 | $5.37 |
Cigna Setting Professional Modifier None Typical Low $5.89 Median $6.03 Typical High $7.94 | Professional | None | $5.89 | $6.03 | $7.94 |
Hally Health Setting Professional Modifier None Typical Low $5.13 Median $5.75 Typical High $21.88 | Professional | None | $5.13 | $5.75 | $21.88 |
Medica Setting Facility Modifier None Typical Low $5.89 Median $6.92 Typical High $10.96 | Facility | None | $5.89 | $6.92 | $10.96 |
Medica Setting Professional Modifier None Typical Low $2.63 Median $4.57 Typical High $83.18 | Professional | None | $2.63 | $4.57 | $83.18 |
Midlands Setting Professional Modifier None Typical Low $6.03 Median $6.03 Typical High $7.08 | Professional | None | $6.03 | $6.03 | $7.08 |
Midlands Setting Professional Modifier None Typical Low $6.31 Median $8.91 Typical High $12.02 | Professional | None | $6.31 | $8.91 | $12.02 |
Oscar Health Setting Professional Modifier None Typical Low $5.50 Median $7.76 Typical High $11.75 | Professional | None | $5.50 | $7.76 | $11.75 |
United Setting Professional Modifier None Typical Low $2.29 Median $2.69 Typical High $4.68 | Professional | None | $2.29 | $2.69 | $4.68 |
Wellmark Setting Professional Modifier None Typical Low $4.37 Median $4.37 Typical High $4.37 | Professional | None | $4.37 | $4.37 | $4.37 |
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 $2.00 Median $2.63 Typical High $2.69 | Professional | 52 · Reduced service | $2.00 | $2.63 | $2.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.79 Median $1.07 Typical High $1.07 | Professional | 53 · Discontinued | $0.79 | $1.07 | $1.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.02 Median $3.98 Typical High $4.07 | Professional | 54 · Surgery only | $3.02 | $3.98 | $4.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.60 Median $0.79 Typical High $0.81 | Professional | 55 · Aftercare only | $0.60 | $0.79 | $0.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.40 Median $0.52 Typical High $0.54 | Professional | 56 · Pre-op care only | $0.40 | $0.52 | $0.54 |
Where Iowa sits
The same service costs 3.8 times more in Rhode Island 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.
Iowa· 9th of 51
$5.25
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.