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 $3.39 Median $3.39 Typical High $3.39 | Facility | None | $3.39 | $3.39 | $3.39 |
Aetna Setting Professional Modifier None Typical Low $2.88 Median $3.39 Typical High $3.72 | Professional | None | $2.88 | $3.39 | $3.72 |
BCBS Setting Professional Modifier None Typical Low $4.27 Median $5.01 Typical High $5.01 | Professional | None | $4.27 | $5.01 | $5.01 |
Cigna Setting Professional Modifier None Typical Low $1.78 Median $1.78 Typical High $1.78 | Professional | None | $1.78 | $1.78 | $1.78 |
Medcost Setting Facility Modifier None Typical Low $3.31 Median $3.39 Typical High $12.02 | Facility | None | $3.31 | $3.39 | $12.02 |
Medcost Setting Professional Modifier None Typical Low $4.79 Median $6.92 Typical High $12.02 | Professional | None | $4.79 | $6.92 | $12.02 |
United Setting Professional Modifier None Typical Low $1.51 Median $2.09 Typical High $2.63 | Professional | None | $1.51 | $2.09 | $2.63 |
6 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 $1.45 Median $1.70 Typical High $1.86 | Professional | 52 · Reduced service | $1.45 | $1.70 | $1.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.56 Median $0.68 Typical High $0.74 | Professional | 53 · Discontinued | $0.56 | $0.68 | $0.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.14 Median $2.51 Typical High $2.75 | Professional | 54 · Surgery only | $2.14 | $2.51 | $2.75 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.44 Median $0.51 Typical High $0.56 | Professional | 55 · Aftercare only | $0.44 | $0.51 | $0.56 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.30 Median $0.34 Typical High $0.37 | Professional | 56 · Pre-op care only | $0.30 | $0.34 | $0.37 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $3.02 Median $3.72 Typical High $6.03 | Professional | 51 · Multiple procedures | $3.02 | $3.72 | $6.03 |
Where South Carolina sits
The same service costs 4.0 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.
South Carolina· 7th of 51
$4.27
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.