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 $0.49 Median $0.49 Typical High $1.51 | Facility | None | $0.49 | $0.49 | $1.51 |
Aetna Setting Professional Modifier None Typical Low $0.48 Median $0.49 Typical High $1.51 | Professional | None | $0.48 | $0.49 | $1.51 |
Cigna Setting Professional Modifier None Typical Low $0.49 Median $0.62 Typical High $1.17 | Professional | None | $0.49 | $0.62 | $1.17 |
Medica Setting Facility Modifier None Typical Low $1.32 Median $1.32 Typical High $1.51 | Facility | None | $1.32 | $1.32 | $1.51 |
Medica Setting Professional Modifier None Typical Low $0.78 Median $0.87 Typical High $7.24 | Professional | None | $0.78 | $0.87 | $7.24 |
Midlands Setting Professional Modifier None Typical Low $0.79 Median $1.17 Typical High $1.17 | Professional | None | $0.79 | $1.17 | $1.17 |
Sanford Health Plan Setting Professional Modifier None Typical Low $0.52 Median $0.52 Typical High $0.52 | Professional | None | $0.52 | $0.52 | $0.52 |
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 |
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 $0.25 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 South Dakota 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.
South Dakota· 11th 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.