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 $0.32 Median $0.32 Typical High $0.32 | Facility | None | $0.32 | $0.32 | $0.32 |
Aetna Setting Professional Modifier None Typical Low $0.28 Median $0.30 Typical High $0.33 | Professional | None | $0.28 | $0.30 | $0.33 |
Cigna Setting Facility Modifier None Typical Low $0.50 Median $0.50 Typical High $0.63 | Facility | None | $0.50 | $0.50 | $0.63 |
Cigna Setting Professional Modifier None Typical Low $0.38 Median $0.47 Typical High $0.56 | Professional | None | $0.38 | $0.47 | $0.56 |
Medica Setting Facility Modifier None Typical Low $0.31 Median $0.51 Typical High $0.52 | Facility | None | $0.31 | $0.51 | $0.52 |
Medica Setting Professional Modifier None Typical Low $0.18 Median $0.22 Typical High $2.19 | Professional | None | $0.18 | $0.22 | $2.19 |
Midlands Setting Professional Modifier None Typical Low $0.48 Median $0.48 Typical High $0.48 | Professional | None | $0.48 | $0.48 | $0.48 |
Midlands Setting Professional Modifier None Typical Low $0.41 Median $0.41 Typical High $0.81 | Professional | None | $0.41 | $0.41 | $0.81 |
Sanford Health Plan Setting Professional Modifier None Typical Low $0.42 Median $0.44 Typical High $0.58 | Professional | None | $0.42 | $0.44 | $0.58 |
United Setting Professional Modifier None Typical Low $0.15 Median $0.18 Typical High $0.37 | Professional | None | $0.15 | $0.18 | $0.37 |
Wellmark Setting Professional Modifier None Typical Low $0.36 Median $0.36 Typical High $0.36 | Professional | None | $0.36 | $0.36 | $0.36 |
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 $0.15 Median $0.15 Typical High $0.17 | Professional | 52 · Reduced service | $0.15 | $0.15 | $0.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.06 Median $0.06 Typical High $0.07 | Professional | 53 · Discontinued | $0.06 | $0.06 | $0.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | 56 · Pre-op care only | $0.03 | $0.03 | $0.03 |
Where South Dakota sits
The same service costs 2.5 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· 15th of 51
$0.37
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.