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 $5.62 Median $5.62 Typical High $5.62 | Facility | None | $5.62 | $5.62 | $5.62 |
Aetna Setting Professional Modifier None Typical Low $4.17 Median $5.62 Typical High $5.75 | Professional | None | $4.17 | $5.62 | $5.75 |
Cigna Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $8.51 | Professional | None | $6.31 | $6.31 | $8.51 |
Hally Health Setting Professional Modifier None Typical Low $5.37 Median $6.03 Typical High $21.88 | Professional | None | $5.37 | $6.03 | $21.88 |
Medica Setting Facility Modifier None Typical Low $6.31 Median $7.24 Typical High $8.91 | Facility | None | $6.31 | $7.24 | $8.91 |
Medica Setting Professional Modifier None Typical Low $2.82 Median $4.90 Typical High $69.18 | Professional | None | $2.82 | $4.90 | $69.18 |
Midlands Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $7.59 | Professional | None | $6.31 | $6.31 | $7.59 |
Midlands Setting Professional Modifier None Typical Low $6.61 Median $9.55 Typical High $12.59 | Professional | None | $6.61 | $9.55 | $12.59 |
Oscar Health Setting Professional Modifier None Typical Low $5.75 Median $8.13 Typical High $12.30 | Professional | None | $5.75 | $8.13 | $12.30 |
United Setting Professional Modifier None Typical Low $2.40 Median $2.82 Typical High $5.01 | Professional | None | $2.40 | $2.82 | $5.01 |
Wellmark Setting Professional Modifier None Typical Low $4.68 Median $4.68 Typical High $4.68 | Professional | None | $4.68 | $4.68 | $4.68 |
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 $2.09 Median $2.82 Typical High $2.82 | Professional | 52 · Reduced service | $2.09 | $2.82 | $2.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.83 Median $1.12 Typical High $1.12 | Professional | 53 · Discontinued | $0.83 | $1.12 | $1.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.16 Median $4.17 Typical High $4.27 | Professional | 54 · Surgery only | $3.16 | $4.17 | $4.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.63 Median $0.83 Typical High $0.85 | Professional | 55 · Aftercare only | $0.63 | $0.83 | $0.85 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.42 Median $0.56 Typical High $0.56 | Professional | 56 · Pre-op care only | $0.42 | $0.56 | $0.56 |
Where Iowa sits
The same service costs 3.0 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· 5th of 51
$5.75
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.