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 $0.56 Median $0.56 Typical High $0.56 | Facility | None | $0.56 | $0.56 | $0.56 |
Aetna Setting Professional Modifier None Typical Low $0.48 Median $0.52 Typical High $0.58 | Professional | None | $0.48 | $0.52 | $0.58 |
Cigna Setting Facility Modifier None Typical Low $1.00 Median $1.00 Typical High $1.26 | Facility | None | $1.00 | $1.00 | $1.26 |
Cigna Setting Professional Modifier None Typical Low $0.76 Median $0.85 Typical High $1.00 | Professional | None | $0.76 | $0.85 | $1.00 |
Medica Setting Facility Modifier None Typical Low $0.54 Median $0.89 Typical High $0.91 | Facility | None | $0.54 | $0.89 | $0.91 |
Medica Setting Professional Modifier None Typical Low $0.31 Median $0.39 Typical High $3.89 | Professional | None | $0.31 | $0.39 | $3.89 |
Midlands Setting Professional Modifier None Typical Low $0.85 Median $0.85 Typical High $0.85 | Professional | None | $0.85 | $0.85 | $0.85 |
Midlands Setting Professional Modifier None Typical Low $0.72 Median $0.72 Typical High $1.41 | Professional | None | $0.72 | $0.72 | $1.41 |
Sanford Health Plan Setting Professional Modifier None Typical Low $0.74 Median $0.78 Typical High $1.02 | Professional | None | $0.74 | $0.78 | $1.02 |
United Setting Professional Modifier None Typical Low $0.26 Median $0.31 Typical High $0.65 | Professional | None | $0.26 | $0.31 | $0.65 |
Wellmark Setting Professional Modifier None Typical Low $0.65 Median $0.65 Typical High $0.65 | Professional | None | $0.65 | $0.65 | $0.65 |
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 $0.27 Median $0.27 Typical High $0.28 | Professional | 52 · Reduced service | $0.27 | $0.27 | $0.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.11 Median $0.11 Typical High $0.12 | Professional | 53 · Discontinued | $0.11 | $0.11 | $0.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.08 Median $0.08 Typical High $0.09 | Professional | 55 · Aftercare only | $0.08 | $0.08 | $0.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.05 Median $0.05 Typical High $0.06 | Professional | 56 · Pre-op care only | $0.05 | $0.05 | $0.06 |
Where South Dakota sits
The same service costs 2.6 times more in Hawaii than in Utah. 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· 12th of 51
$0.65
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.