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 $0.49 Median $0.49 Typical High $0.56 | Facility | None | $0.49 | $0.49 | $0.56 |
Aetna Setting Professional Modifier None Typical Low $0.48 Median $0.52 Typical High $0.56 | Professional | None | $0.48 | $0.52 | $0.56 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.32 Median $0.41 Typical High $0.59 | Professional | None | $0.32 | $0.41 | $0.59 |
CareSource Setting Facility Modifier None Typical Low $0.87 Median $0.87 Typical High $0.87 | Facility | None | $0.87 | $0.87 | $0.87 |
CareSource Setting Professional Modifier None Typical Low $0.93 Median $1.10 Typical High $1.41 | Professional | None | $0.93 | $1.10 | $1.41 |
Cigna Setting Facility Modifier None Typical Low $1.23 Median $1.23 Typical High $1.23 | Facility | None | $1.23 | $1.23 | $1.23 |
Cigna Setting Professional Modifier None Typical Low $0.45 Median $0.45 Typical High $4.37 | Professional | None | $0.45 | $0.45 | $4.37 |
Molina Setting Professional Modifier None Typical Low $0.51 Median $1.26 Typical High $1.26 | Professional | None | $0.51 | $1.26 | $1.26 |
United Setting Professional Modifier None Typical Low $0.28 Median $0.38 Typical High $0.52 | Professional | None | $0.28 | $0.38 | $0.52 |
6 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 $0.24 Median $0.27 Typical High $0.28 | Professional | 52 · Reduced service | $0.24 | $0.27 | $0.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.10 Median $0.11 Typical High $0.11 | Professional | 53 · Discontinued | $0.10 | $0.11 | $0.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.07 Median $0.08 Typical High $0.08 | Professional | 55 · Aftercare only | $0.07 | $0.08 | $0.08 |
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 |
Ambetter Setting Professional Modifier A1 · Dressing, 1 wound Typical Low $63.10 Median $63.10 Typical High $63.10 | Professional | A1 · Dressing, 1 wound | $63.10 | $63.10 | $63.10 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.28 Median $0.38 Typical High $0.41 | Professional | UE · Used equipment | $0.28 | $0.38 | $0.41 |
Where Kentucky 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.
Kentucky· 48th of 51
$0.43
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.