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 $2.14 Median $2.14 Typical High $4.37 | Facility | None | $2.14 | $2.14 | $4.37 |
Aetna Setting Professional Modifier None Typical Low $2.14 Median $2.14 Typical High $3.16 | Professional | None | $2.14 | $2.14 | $3.16 |
Cigna Setting Professional Modifier None Typical Low $2.19 Median $2.69 Typical High $2.95 | Professional | None | $2.19 | $2.69 | $2.95 |
Medica Setting Facility Modifier None Typical Low $2.82 Median $3.31 Typical High $4.37 | Facility | None | $2.82 | $3.31 | $4.37 |
Medica Setting Professional Modifier None Typical Low $1.95 Median $11.48 Typical High $147.91 | Professional | None | $1.95 | $11.48 | $147.91 |
Midlands Setting Professional Modifier None Typical Low $2.57 Median $2.95 Typical High $2.95 | Professional | None | $2.57 | $2.95 | $2.95 |
Midlands Setting Professional Modifier None Typical Low $2.19 Median $2.19 Typical High $2.19 | Professional | None | $2.19 | $2.19 | $2.19 |
Sanford Health Plan Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
United Setting Professional Modifier None Typical Low $2.19 Median $2.29 Typical High $11.75 | Professional | None | $2.19 | $2.29 | $11.75 |
Wellmark Setting Facility Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Facility | None | $2.34 | $2.34 | $2.34 |
Wellmark Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
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 $1.07 Median $1.07 Typical High $2.14 | Professional | 52 · Reduced service | $1.07 | $1.07 | $2.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.43 Median $0.43 Typical High $0.85 | Professional | 53 · Discontinued | $0.43 | $0.43 | $0.85 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.32 Median $0.32 Typical High $0.65 | Professional | 55 · Aftercare only | $0.32 | $0.32 | $0.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.21 Median $0.21 Typical High $0.43 | Professional | 56 · Pre-op care only | $0.21 | $0.21 | $0.43 |
Where South Dakota sits
The same service costs 1.9 times more in Wyoming than in Pennsylvania. 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· 8th of 51
$2.57
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.