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 $11.22 Median $11.22 Typical High $11.22 | Facility | None | $11.22 | $11.22 | $11.22 |
Aetna Setting Professional Modifier None Typical Low $5.13 Median $10.96 Typical High $11.22 | Professional | None | $5.13 | $10.96 | $11.22 |
BCBS Kansas Setting Professional Modifier None Typical Low $9.12 Median $9.12 Typical High $9.12 | Professional | None | $9.12 | $9.12 | $9.12 |
Cigna Setting Professional Modifier None Typical Low $3.47 Median $3.47 Typical High $3.47 | Professional | None | $3.47 | $3.47 | $3.47 |
Medica Setting Facility Modifier None Typical Low $6.92 Median $6.92 Typical High $17.38 | Facility | None | $6.92 | $6.92 | $17.38 |
Medica Setting Professional Modifier None Typical Low $3.55 Median $4.17 Typical High $138.04 | Professional | None | $3.55 | $4.17 | $138.04 |
United Setting Professional Modifier None Typical Low $2.82 Median $4.17 Typical High $5.37 | Professional | None | $2.82 | $4.17 | $5.37 |
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 $2.57 Median $5.50 Typical High $5.62 | Professional | 52 · Reduced service | $2.57 | $5.50 | $5.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.02 Median $2.19 Typical High $2.24 | Professional | 53 · Discontinued | $1.02 | $2.19 | $2.24 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.89 Median $8.13 Typical High $8.32 | Professional | 54 · Surgery only | $3.89 | $8.13 | $8.32 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.78 Median $1.62 Typical High $1.66 | Professional | 55 · Aftercare only | $0.78 | $1.62 | $1.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.51 Median $1.10 Typical High $1.12 | Professional | 56 · Pre-op care only | $0.51 | $1.10 | $1.12 |
Where Kansas sits
The same service costs 4.1 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.
Kansas· 32nd of 51
$5.13
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.