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 $0.52 Median $1.51 Typical High $1.51 | Facility | None | $0.52 | $1.51 | $1.51 |
Aetna Setting Professional Modifier None Typical Low $0.49 Median $0.49 Typical High $1.51 | Professional | None | $0.49 | $0.49 | $1.51 |
Cigna Setting Professional Modifier None Typical Low $0.49 Median $0.62 Typical High $1.20 | Professional | None | $0.49 | $0.62 | $1.20 |
Hally Health Setting Professional Modifier None Typical Low $0.63 Median $0.69 Typical High $8.32 | Professional | None | $0.63 | $0.69 | $8.32 |
Medica Setting Facility Modifier None Typical Low $0.78 Median $1.29 Typical High $4.79 | Facility | None | $0.78 | $1.29 | $4.79 |
Medica Setting Professional Modifier None Typical Low $0.78 Median $1.05 Typical High $7.24 | Professional | None | $0.78 | $1.05 | $7.24 |
Midlands Setting Professional Modifier None Typical Low $0.62 Median $0.62 Typical High $4.90 | Professional | None | $0.62 | $0.62 | $4.90 |
Midlands Setting Professional Modifier None Typical Low $0.76 Median $4.90 Typical High $4.90 | Professional | None | $0.76 | $4.90 | $4.90 |
Oscar Health Setting Professional Modifier None Typical Low $0.56 Median $0.91 Typical High $1.29 | Professional | None | $0.56 | $0.91 | $1.29 |
United Setting Facility Modifier None Typical Low $0.49 Median $0.49 Typical High $0.49 | Facility | None | $0.49 | $0.49 | $0.49 |
United Setting Professional Modifier None Typical Low $0.52 Median $0.55 Typical High $0.62 | Professional | None | $0.52 | $0.55 | $0.62 |
Wellmark Setting Facility Modifier None Typical Low $0.56 Median $0.56 Typical High $0.56 | Facility | None | $0.56 | $0.56 | $0.56 |
Wellmark Setting Professional Modifier None Typical Low $0.56 Median $0.56 Typical High $0.56 | Professional | None | $0.56 | $0.56 | $0.56 |
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 $0.26 Median $0.76 Typical High $0.76 | Facility | 52 · Reduced service | $0.26 | $0.76 | $0.76 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.10 Median $0.30 Typical High $0.30 | Facility | 53 · Discontinued | $0.10 | $0.30 | $0.30 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.08 Median $0.23 Typical High $0.23 | Facility | 55 · Aftercare only | $0.08 | $0.23 | $0.23 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.05 Median $0.15 Typical High $0.15 | Facility | 56 · Pre-op care only | $0.05 | $0.15 | $0.15 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.25 Median $0.25 Typical High $0.76 | Professional | 52 · Reduced service | $0.25 | $0.25 | $0.76 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.10 Median $0.10 Typical High $0.30 | Professional | 53 · Discontinued | $0.10 | $0.10 | $0.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.07 Median $0.07 Typical High $0.23 | Professional | 55 · Aftercare only | $0.07 | $0.07 | $0.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.05 Median $0.05 Typical High $0.15 | Professional | 56 · Pre-op care only | $0.05 | $0.05 | $0.15 |
Where Iowa sits
The same service costs 2.6 times more in Wyoming than in Illinois. 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· 10th of 51
$0.62
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.