How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $0.95 Typical High $1.05 | Facility | None | $0.40 | $0.95 | $1.05 |
Aetna Setting Professional Modifier None Typical Low $0.40 Median $0.65 Typical High $1.05 | Professional | None | $0.40 | $0.65 | $1.05 |
Cigna Setting Professional Modifier None Typical Low $0.41 Median $0.52 Typical High $0.58 | Professional | None | $0.41 | $0.52 | $0.58 |
Hally Health Setting Professional Modifier None Typical Low $0.43 Median $0.78 Typical High $9.55 | Professional | None | $0.43 | $0.78 | $9.55 |
Medica Setting Facility Modifier None Typical Low $0.54 Median $1.00 Typical High $5.75 | Facility | None | $0.54 | $1.00 | $5.75 |
Medica Setting Professional Modifier None Typical Low $0.48 Median $0.51 Typical High $1.45 | Professional | None | $0.48 | $0.51 | $1.45 |
Midlands Setting Professional Modifier None Typical Low $0.60 Median $0.60 Typical High $0.66 | Professional | None | $0.60 | $0.60 | $0.66 |
United Setting Professional Modifier None Typical Low $0.43 Median $0.43 Typical High $0.46 | Professional | None | $0.43 | $0.43 | $0.46 |
Wellmark Setting Facility Modifier None Typical Low $0.43 Median $0.43 Typical High $0.43 | Facility | None | $0.43 | $0.43 | $0.43 |
8 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 Facility Modifier 52 · Reduced service Typical Low $0.22 Median $0.52 Typical High $0.52 | Facility | 52 · Reduced service | $0.22 | $0.52 | $0.52 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.09 Median $0.21 Typical High $0.21 | Facility | 53 · Discontinued | $0.09 | $0.21 | $0.21 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.06 Median $0.16 Typical High $0.16 | Facility | 55 · Aftercare only | $0.06 | $0.16 | $0.16 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.11 Typical High $0.11 | Facility | 56 · Pre-op care only | $0.04 | $0.11 | $0.11 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.20 Median $0.32 Typical High $0.52 | Professional | 52 · Reduced service | $0.20 | $0.32 | $0.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.08 Median $0.13 Typical High $0.21 | Professional | 53 · Discontinued | $0.08 | $0.13 | $0.21 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.06 Median $0.10 Typical High $0.16 | Professional | 55 · Aftercare only | $0.06 | $0.10 | $0.16 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.06 Typical High $0.11 | Professional | 56 · Pre-op care only | $0.04 | $0.06 | $0.11 |
Where Iowa sits
The same service costs 4.0 times more in Texas than in Georgia. 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.
Iowa· 17th of 51
$0.48
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.