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 $0.65 Median $0.65 Typical High $0.65 | Facility | None | $0.65 | $0.65 | $0.65 |
Aetna Setting Professional Modifier None Typical Low $0.26 Median $0.60 Typical High $0.65 | Professional | None | $0.26 | $0.60 | $0.65 |
Cigna Setting Facility Modifier None Typical Low $1.51 Median $1.51 Typical High $1.86 | Facility | None | $1.51 | $1.51 | $1.86 |
Cigna Setting Professional Modifier None Typical Low $0.95 Median $1.12 Typical High $1.41 | Professional | None | $0.95 | $1.12 | $1.41 |
Medica Setting Facility Modifier None Typical Low $0.59 Median $1.00 Typical High $1.05 | Facility | None | $0.59 | $1.00 | $1.05 |
Medica Setting Professional Modifier None Typical Low $0.35 Median $0.44 Typical High $4.37 | Professional | None | $0.35 | $0.44 | $4.37 |
Midlands Setting Professional Modifier None Typical Low $0.95 Median $0.95 Typical High $0.95 | Professional | None | $0.95 | $0.95 | $0.95 |
Midlands Setting Professional Modifier None Typical Low $0.79 Median $0.79 Typical High $1.55 | Professional | None | $0.79 | $0.79 | $1.55 |
Sanford Health Plan Setting Professional Modifier None Typical Low $0.83 Median $0.87 Typical High $1.15 | Professional | None | $0.83 | $0.87 | $1.15 |
United Setting Professional Modifier None Typical Low $0.28 Median $0.35 Typical High $0.72 | Professional | None | $0.28 | $0.35 | $0.72 |
Wellmark Setting Professional Modifier None Typical Low $0.72 Median $0.72 Typical High $0.72 | Professional | None | $0.72 | $0.72 | $0.72 |
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 $0.30 Median $0.30 Typical High $0.33 | Professional | 52 · Reduced service | $0.30 | $0.30 | $0.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.12 Median $0.12 Typical High $0.13 | Professional | 53 · Discontinued | $0.12 | $0.12 | $0.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.09 Median $0.09 Typical High $0.10 | Professional | 55 · Aftercare only | $0.09 | $0.09 | $0.10 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.06 Median $0.06 Typical High $0.07 | Professional | 56 · Pre-op care only | $0.06 | $0.06 | $0.07 |
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· 11th of 51
$0.72
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.