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 $1.41 Median $1.41 Typical High $1.41 | Facility | None | $1.41 | $1.41 | $1.41 |
Aetna Setting Professional Modifier None Typical Low $1.32 Median $1.32 Typical High $1.45 | Professional | None | $1.32 | $1.32 | $1.45 |
Cigna Setting Facility Modifier None Typical Low $3.02 Median $3.02 Typical High $3.72 | Facility | None | $3.02 | $3.02 | $3.72 |
Cigna Setting Professional Modifier None Typical Low $2.14 Median $2.24 Typical High $2.82 | Professional | None | $2.14 | $2.24 | $2.82 |
Medica Setting Facility Modifier None Typical Low $1.32 Median $2.24 Typical High $2.29 | Facility | None | $1.32 | $2.24 | $2.29 |
Medica Setting Professional Modifier None Typical Low $0.78 Median $0.98 Typical High $9.77 | Professional | None | $0.78 | $0.98 | $9.77 |
Midlands Setting Professional Modifier None Typical Low $2.14 Median $2.14 Typical High $2.14 | Professional | None | $2.14 | $2.14 | $2.14 |
Midlands Setting Professional Modifier None Typical Low $1.78 Median $1.78 Typical High $3.47 | Professional | None | $1.78 | $1.78 | $3.47 |
Sanford Health Plan Setting Professional Modifier None Typical Low $1.86 Median $1.95 Typical High $2.57 | Professional | None | $1.86 | $1.95 | $2.57 |
United Setting Professional Modifier None Typical Low $0.65 Median $0.78 Typical High $1.62 | Professional | None | $0.65 | $0.78 | $1.62 |
Wellmark Setting Professional Modifier None Typical Low $1.58 Median $1.58 Typical High $1.58 | Professional | None | $1.58 | $1.58 | $1.58 |
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 $0.68 Median $0.68 Typical High $0.72 | Professional | 52 · Reduced service | $0.68 | $0.68 | $0.72 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.27 Median $0.27 Typical High $0.28 | Professional | 53 · Discontinued | $0.27 | $0.27 | $0.28 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.20 Median $0.20 Typical High $0.22 | Professional | 55 · Aftercare only | $0.20 | $0.20 | $0.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.13 Median $0.13 Typical High $0.14 | Professional | 56 · Pre-op care only | $0.13 | $0.13 | $0.14 |
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· 15th of 51
$1.62
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.