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 $1.00 Median $1.00 Typical High $2.09 | Facility | None | $1.00 | $1.00 | $2.09 |
Aetna Setting Professional Modifier None Typical Low $1.00 Median $1.26 Typical High $1.38 | Professional | None | $1.00 | $1.26 | $1.38 |
Cigna Setting Facility Modifier None Typical Low $1.10 Median $1.10 Typical High $1.10 | Facility | None | $1.10 | $1.10 | $1.10 |
Cigna Setting Professional Modifier None Typical Low $1.29 Median $1.35 Typical High $1.58 | Professional | None | $1.29 | $1.35 | $1.58 |
Hally Health Setting Professional Modifier None Typical Low $1.07 Median $1.10 Typical High $2.40 | Professional | None | $1.07 | $1.10 | $2.40 |
Medica Setting Facility Modifier None Typical Low $1.00 Median $1.35 Typical High $1.62 | Facility | None | $1.00 | $1.35 | $1.62 |
Medica Setting Professional Modifier None Typical Low $1.12 Median $1.15 Typical High $2.14 | Professional | None | $1.12 | $1.15 | $2.14 |
Midlands Setting Professional Modifier None Typical Low $1.35 Median $1.45 Typical High $1.45 | Professional | None | $1.35 | $1.45 | $1.45 |
Midlands Setting Facility Modifier None Typical Low $1.10 Median $1.10 Typical High $1.10 | Facility | None | $1.10 | $1.10 | $1.10 |
United Setting Facility Modifier None Typical Low $1.26 Median $1.26 Typical High $1.26 | Facility | None | $1.26 | $1.26 | $1.26 |
United Setting Professional Modifier None Typical Low $1.38 Median $1.38 Typical High $1.48 | Professional | None | $1.38 | $1.38 | $1.48 |
Wellmark Setting Facility Modifier None Typical Low $1.38 Median $1.38 Typical High $1.38 | Facility | None | $1.38 | $1.38 | $1.38 |
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 $0.51 Median $0.51 Typical High $1.05 | Facility | 52 · Reduced service | $0.51 | $0.51 | $1.05 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.20 Median $0.20 Typical High $0.42 | Facility | 53 · Discontinued | $0.20 | $0.20 | $0.42 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.15 Median $0.15 Typical High $0.31 | Facility | 55 · Aftercare only | $0.15 | $0.15 | $0.31 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.10 Median $0.10 Typical High $0.21 | Facility | 56 · Pre-op care only | $0.10 | $0.10 | $0.21 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.51 Median $0.63 Typical High $0.71 | Professional | 52 · Reduced service | $0.51 | $0.63 | $0.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.20 Median $0.25 Typical High $0.28 | Professional | 53 · Discontinued | $0.20 | $0.25 | $0.28 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.15 Median $0.19 Typical High $0.21 | Professional | 55 · Aftercare only | $0.15 | $0.19 | $0.21 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.10 Median $0.13 Typical High $0.14 | Professional | 56 · Pre-op care only | $0.10 | $0.13 | $0.14 |
Where Iowa sits
The same service costs 1.7 times more in Arizona than in Oklahoma. 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· 33rd of 51
$1.35
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.