How much rates vary
Facilitymedian $4 · 10th to 90th $3 to $13Professionalmedian $3 · 10th to 90th $1 to $7
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 $1.20 Median $1.20 Typical High $3.16 | Facility | None | $1.20 | $1.20 | $3.16 |
Aetna Setting Professional Modifier None Typical Low $1.20 Median $3.16 Typical High $7.08 | Professional | None | $1.20 | $3.16 | $7.08 |
Aetna Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $1.20 Median $1.20 Typical High $1.20 | Professional | AU · Urologic/ostomy supply | $1.20 | $1.20 | $1.20 |
Anthem BCBS Setting Facility Modifier None Typical Low $4.47 Median $4.90 Typical High $7.41 | Facility | None | $4.47 | $4.90 | $7.41 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.91 Median $0.91 Typical High $4.37 | Professional | None | $0.91 | $0.91 | $4.37 |
Anthem BCBS Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $4.17 Median $4.17 Typical High $5.01 | Professional | AU · Urologic/ostomy supply | $4.17 | $4.17 | $5.01 |
Cigna Setting Facility Modifier None Typical Low $12.59 Median $14.45 Typical High $21.38 | Facility | None | $12.59 | $14.45 | $21.38 |
Cigna Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $7.41 | Professional | None | $2.24 | $2.24 | $7.41 |
DeanCare Setting Facility Modifier None Typical Low $2.51 Median $4.37 Typical High $4.57 | Facility | None | $2.51 | $4.37 | $4.57 |
DeanCare Setting Professional Modifier None Typical Low $3.98 Median $7.59 Typical High $8.71 | Professional | None | $3.98 | $7.59 | $8.71 |
DeanCare Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $3.98 Median $8.13 Typical High $8.71 | Professional | AU · Urologic/ostomy supply | $3.98 | $8.13 | $8.71 |
Medica Setting Facility Modifier None Typical Low $3.63 Median $4.37 Typical High $8.91 | Facility | None | $3.63 | $4.37 | $8.91 |
Medica Setting Professional Modifier None Typical Low $2.04 Median $2.88 Typical High $21.88 | Professional | None | $2.04 | $2.88 | $21.88 |
Network Health Setting Facility Modifier None Typical Low $7.08 Median $7.08 Typical High $7.08 | Facility | None | $7.08 | $7.08 | $7.08 |
Network Health Setting Professional Modifier None Typical Low $3.89 Median $4.07 Typical High $7.41 | Professional | None | $3.89 | $4.07 | $7.41 |
Network Health Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $3.89 Median $4.07 Typical High $8.71 | Professional | AU · Urologic/ostomy supply | $3.89 | $4.07 | $8.71 |
Prevea360 Setting Facility Modifier None Typical Low $2.51 Median $4.37 Typical High $4.57 | Facility | None | $2.51 | $4.37 | $4.57 |
Prevea360 Setting Professional Modifier None Typical Low $2.51 Median $4.37 Typical High $4.37 | Professional | None | $2.51 | $4.37 | $4.37 |
Quartz Setting Professional Modifier None Typical Low $4.47 Median $6.61 Typical High $9.33 | Professional | None | $4.47 | $6.61 | $9.33 |
Quartz Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | None | $2.24 | $2.24 | $2.24 |
Security Health Setting Professional Modifier None Typical Low $4.47 Median $4.47 Typical High $4.47 | Professional | None | $4.47 | $4.47 | $4.47 |
Security Health Setting Professional Modifier None Typical Low $4.47 Median $4.47 Typical High $5.75 | Professional | None | $4.47 | $4.47 | $5.75 |
Security Health Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $4.47 Median $4.47 Typical High $5.75 | Professional | AU · Urologic/ostomy supply | $4.47 | $4.47 | $5.75 |
United Setting Professional Modifier None Typical Low $1.45 Median $2.19 Typical High $4.07 | Professional | None | $1.45 | $2.19 | $4.07 |
12 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 $1.58 Median $1.58 Typical High $6.03 | Professional | 52 · Reduced service | $1.58 | $1.58 | $6.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.63 Median $0.63 Typical High $2.40 | Professional | 53 · Discontinued | $0.63 | $0.63 | $2.40 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.47 Median $0.47 Typical High $1.82 | Professional | 55 · Aftercare only | $0.47 | $0.47 | $1.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.32 Median $0.32 Typical High $1.20 | Professional | 56 · Pre-op care only | $0.32 | $0.32 | $1.20 |
DeanCare Setting Professional Modifier AV · With prosthetic/orthotic Typical Low $3.98 Median $8.13 Typical High $8.71 | Professional | AV · With prosthetic/orthotic | $3.98 | $8.13 | $8.71 |
DeanCare Setting Professional Modifier AW · With surgical dressing Typical Low $3.98 Median $8.13 Typical High $8.71 | Professional | AW · With surgical dressing | $3.98 | $8.13 | $8.71 |
DeanCare Setting Professional Modifier KF · Class III device Typical Low $3.98 Median $8.13 Typical High $8.71 | Professional | KF · Class III device | $3.98 | $8.13 | $8.71 |
DeanCare Setting Professional Modifier KL · Delivered by mail Typical Low $3.98 Median $8.13 Typical High $8.71 | Professional | KL · Delivered by mail | $3.98 | $8.13 | $8.71 |
DeanCare Setting Professional Modifier KM · Facial prosthesis, new mold Typical Low $3.98 Median $8.13 Typical High $8.71 | Professional | KM · Facial prosthesis, new mold | $3.98 | $8.13 | $8.71 |
DeanCare Setting Professional Modifier KN · Facial prosthesis, prior mold Typical Low $3.98 Median $8.13 Typical High $8.71 | Professional | KN · Facial prosthesis, prior mold | $3.98 | $8.13 | $8.71 |
DeanCare Setting Professional Modifier RR · Rental Typical Low $3.98 Median $8.13 Typical High $8.71 | Professional | RR · Rental | $3.98 | $8.13 | $8.71 |
DeanCare Setting Professional Modifier UE · Used equipment Typical Low $3.98 Median $8.13 Typical High $8.71 | Professional | UE · Used equipment | $3.98 | $8.13 | $8.71 |
Where Wisconsin sits
The same service costs 4.4 times more in Minnesota than in New Hampshire. 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.
Wisconsin· 14th of 51
$3.16
MN $5.25NH $1.20
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.