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 $0.42 Median $0.42 Typical High $0.98 | Facility | None | $0.42 | $0.42 | $0.98 |
Aetna Setting Professional Modifier None Typical Low $0.40 Median $0.42 Typical High $0.91 | Professional | None | $0.40 | $0.42 | $0.91 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.50 Median $0.50 Typical High $0.50 | Facility | None | $0.50 | $0.50 | $0.50 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.40 Median $0.44 Typical High $0.50 | Professional | None | $0.40 | $0.44 | $0.50 |
Cigna Setting Facility Modifier None Typical Low $0.62 Median $1.17 Typical High $1.32 | Facility | None | $0.62 | $1.17 | $1.32 |
Cigna Setting Professional Modifier None Typical Low $0.40 Median $0.56 Typical High $0.85 | Professional | None | $0.40 | $0.56 | $0.85 |
DeanCare Setting Facility Modifier None Typical Low $0.43 Median $0.43 Typical High $0.71 | Facility | None | $0.43 | $0.43 | $0.71 |
DeanCare Setting Professional Modifier None Typical Low $0.65 Median $0.85 Typical High $0.85 | Professional | None | $0.65 | $0.85 | $0.85 |
Medica Setting Facility Modifier None Typical Low $0.87 Median $5.01 Typical High $8.91 | Facility | None | $0.87 | $5.01 | $8.91 |
Medica Setting Professional Modifier None Typical Low $0.48 Median $0.48 Typical High $0.78 | Professional | None | $0.48 | $0.48 | $0.78 |
Network Health Setting Facility Modifier None Typical Low $0.52 Median $0.52 Typical High $1.51 | Facility | None | $0.52 | $0.52 | $1.51 |
Prevea360 Setting Facility Modifier None Typical Low $0.43 Median $0.43 Typical High $0.71 | Facility | None | $0.43 | $0.43 | $0.71 |
Prevea360 Setting Professional Modifier None Typical Low $0.65 Median $0.85 Typical High $0.85 | Professional | None | $0.65 | $0.85 | $0.85 |
Quartz Setting Professional Modifier None Typical Low $0.40 Median $0.69 Typical High $1.12 | Professional | None | $0.40 | $0.69 | $1.12 |
Quartz Setting Facility Modifier None Typical Low $0.52 Median $1.23 Typical High $1.23 | Facility | None | $0.52 | $1.23 | $1.23 |
Quartz Setting Professional Modifier None Typical Low $0.40 Median $0.40 Typical High $0.40 | Professional | None | $0.40 | $0.40 | $0.40 |
Security Health Setting Professional Modifier None Typical Low $0.54 Median $0.55 Typical High $0.83 | Professional | None | $0.54 | $0.55 | $0.83 |
United Setting Professional Modifier None Typical Low $0.43 Median $0.43 Typical High $0.59 | Professional | None | $0.43 | $0.43 | $0.59 |
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 $0.21 Median $0.21 Typical High $6.46 | Professional | 52 · Reduced service | $0.21 | $0.21 | $6.46 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.08 Median $0.08 Typical High $6.46 | Professional | 53 · Discontinued | $0.08 | $0.08 | $6.46 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.06 Median $0.06 Typical High $4.79 | Professional | 55 · Aftercare only | $0.06 | $0.06 | $4.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $3.24 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $3.24 |
Where Wisconsin 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.
Wisconsin· 15th 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.