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 $0.44 Median $0.44 Typical High $0.44 | Facility | None | $0.44 | $0.44 | $0.44 |
Aetna Setting Professional Modifier None Typical Low $0.37 Median $0.44 Typical High $0.48 | Professional | None | $0.37 | $0.44 | $0.48 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.19 Median $0.22 Typical High $0.24 | Professional | 52 · Reduced service | $0.19 | $0.22 | $0.24 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.08 Median $0.09 Typical High $0.10 | Professional | 53 · Discontinued | $0.08 | $0.09 | $0.10 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.06 Median $0.07 Typical High $0.07 | Professional | 55 · Aftercare only | $0.06 | $0.07 | $0.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.05 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $0.05 |
BCBS South Carolina Setting Professional Modifier None Typical Low $0.55 Median $0.58 Typical High $0.58 | Professional | None | $0.55 | $0.58 | $0.58 |
Cigna Setting Professional Modifier None Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | None | $0.28 | $0.28 | $0.28 |
Medcost Setting Facility Modifier None Typical Low $0.41 Median $0.44 Typical High $1.51 | Facility | None | $0.41 | $0.44 | $1.51 |
Medcost Setting Professional Modifier None Typical Low $0.43 Median $0.62 Typical High $1.00 | Professional | None | $0.43 | $0.62 | $1.00 |
United Setting Professional Modifier None Typical Low $0.20 Median $0.28 Typical High $0.37 | Professional | None | $0.20 | $0.28 | $0.37 |
2 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 |
|---|---|---|---|---|---|
Ambetter Setting Professional Modifier A1 · Dressing, 1 wound Typical Low $36.31 Median $36.31 Typical High $36.31 | Professional | A1 · Dressing, 1 wound | $36.31 | $36.31 | $36.31 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $0.22 Median $0.39 Typical High $0.50 | Professional | 51 · Multiple procedures | $0.22 | $0.39 | $0.50 |
Where South Carolina 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 Carolina· 5th of 51
$0.55
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.