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 $0.71 Median $0.71 Typical High $0.71 | Facility | None | $0.71 | $0.71 | $0.71 |
Aetna Setting Professional Modifier None Typical Low $0.65 Median $0.65 Typical High $0.71 | Professional | None | $0.65 | $0.65 | $0.71 |
Cigna Setting Facility Modifier None Typical Low $1.51 Median $1.51 Typical High $1.86 | Facility | None | $1.51 | $1.51 | $1.86 |
Cigna Setting Professional Modifier None Typical Low $1.05 Median $1.12 Typical High $1.41 | Professional | None | $1.05 | $1.12 | $1.41 |
Medica Setting Facility Modifier None Typical Low $0.65 Median $1.10 Typical High $1.12 | Facility | None | $0.65 | $1.10 | $1.12 |
Medica Setting Professional Modifier None Typical Low $0.38 Median $0.48 Typical High $4.68 | Professional | None | $0.38 | $0.48 | $4.68 |
Midlands Setting Professional Modifier None Typical Low $1.05 Median $1.05 Typical High $1.05 | Professional | None | $1.05 | $1.05 | $1.05 |
Midlands Setting Professional Modifier None Typical Low $0.87 Median $0.87 Typical High $1.70 | Professional | None | $0.87 | $0.87 | $1.70 |
Sanford Health Plan Setting Professional Modifier None Typical Low $0.91 Median $0.95 Typical High $1.26 | Professional | None | $0.91 | $0.95 | $1.26 |
United Setting Professional Modifier None Typical Low $0.32 Median $0.38 Typical High $0.79 | Professional | None | $0.32 | $0.38 | $0.79 |
Wellmark Setting Professional Modifier None Typical Low $0.78 Median $0.78 Typical High $0.78 | Professional | None | $0.78 | $0.78 | $0.78 |
4 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 $0.33 Median $0.33 Typical High $0.35 | Professional | 52 · Reduced service | $0.33 | $0.33 | $0.35 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.13 Median $0.13 Typical High $0.14 | Professional | 53 · Discontinued | $0.13 | $0.13 | $0.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.10 Median $0.10 Typical High $0.11 | Professional | 55 · Aftercare only | $0.10 | $0.10 | $0.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.07 Median $0.07 Typical High $0.07 | Professional | 56 · Pre-op care only | $0.07 | $0.07 | $0.07 |
Where South Dakota sits
The same service costs 2.6 times more in Hawaii than in Colorado. 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 Dakota· 14th of 51
$0.79
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.