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 $0.40 Median $0.40 Typical High $0.40 | Facility | None | $0.40 | $0.40 | $0.40 |
Aetna Setting Professional Modifier None Typical Low $0.37 Median $0.37 Typical High $0.40 | Professional | None | $0.37 | $0.37 | $0.40 |
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 $0.59 Median $0.76 Typical High $0.93 | Professional | None | $0.59 | $0.76 | $0.93 |
Medica Setting Facility Modifier None Typical Low $0.39 Median $0.63 Typical High $0.65 | Facility | None | $0.39 | $0.63 | $0.65 |
Medica Setting Professional Modifier None Typical Low $0.23 Median $0.28 Typical High $2.69 | Professional | None | $0.23 | $0.28 | $2.69 |
Midlands Setting Professional Modifier None Typical Low $0.59 Median $0.59 Typical High $0.59 | Professional | None | $0.59 | $0.59 | $0.59 |
Midlands Setting Professional Modifier None Typical Low $0.51 Median $0.51 Typical High $1.00 | Professional | None | $0.51 | $0.51 | $1.00 |
Sanford Health Plan Setting Professional Modifier None Typical Low $0.52 Median $0.54 Typical High $0.71 | Professional | None | $0.52 | $0.54 | $0.71 |
United Setting Professional Modifier None Typical Low $0.18 Median $0.23 Typical High $0.46 | Professional | None | $0.18 | $0.23 | $0.46 |
Wellmark Setting Professional Modifier None Typical Low $0.44 Median $0.44 Typical High $0.44 | Professional | None | $0.44 | $0.44 | $0.44 |
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 $0.19 Median $0.19 Typical High $0.20 | Professional | 52 · Reduced service | $0.19 | $0.19 | $0.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.07 Median $0.07 Typical High $0.08 | Professional | 53 · Discontinued | $0.07 | $0.07 | $0.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.06 Median $0.06 Typical High $0.06 | Professional | 55 · Aftercare only | $0.06 | $0.06 | $0.06 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.04 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $0.04 |
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· 14th of 51
$0.46
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.