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 $0.79 Median $0.79 Typical High $0.79 | Facility | None | $0.79 | $0.79 | $0.79 |
Aetna Setting Professional Modifier None Typical Low $0.76 Median $0.76 Typical High $0.81 | Professional | None | $0.76 | $0.76 | $0.81 |
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 $1.12 Median $1.20 Typical High $1.41 | Professional | None | $1.12 | $1.20 | $1.41 |
Medica Setting Facility Modifier None Typical Low $0.72 Median $1.26 Typical High $1.29 | Facility | None | $0.72 | $1.26 | $1.29 |
Medica Setting Professional Modifier None Typical Low $0.44 Median $0.55 Typical High $5.50 | Professional | None | $0.44 | $0.55 | $5.50 |
Midlands Setting Professional Modifier None Typical Low $1.20 Median $1.20 Typical High $1.20 | Professional | None | $1.20 | $1.20 | $1.20 |
Midlands Setting Professional Modifier None Typical Low $1.00 Median $1.00 Typical High $1.95 | Professional | None | $1.00 | $1.00 | $1.95 |
Sanford Health Plan Setting Professional Modifier None Typical Low $1.05 Median $1.10 Typical High $1.45 | Professional | None | $1.05 | $1.10 | $1.45 |
United Setting Professional Modifier None Typical Low $0.36 Median $0.44 Typical High $0.91 | Professional | None | $0.36 | $0.44 | $0.91 |
Wellmark Setting Professional Modifier None Typical Low $0.89 Median $0.89 Typical High $0.89 | Professional | None | $0.89 | $0.89 | $0.89 |
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 $0.38 Median $0.38 Typical High $0.41 | Professional | 52 · Reduced service | $0.38 | $0.38 | $0.41 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.15 Median $0.15 Typical High $0.16 | Professional | 53 · Discontinued | $0.15 | $0.15 | $0.16 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.11 Median $0.11 Typical High $0.12 | Professional | 55 · Aftercare only | $0.11 | $0.11 | $0.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.08 Median $0.08 Typical High $0.08 | Professional | 56 · Pre-op care only | $0.08 | $0.08 | $0.08 |
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
$0.91
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.