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 $1.78 Median $1.78 Typical High $2.69 | Facility | None | $1.78 | $1.78 | $2.69 |
Aetna Setting Professional Modifier None Typical Low $1.78 Median $2.00 Typical High $2.00 | Professional | None | $1.78 | $2.00 | $2.00 |
Cigna Setting Professional Modifier None Typical Low $2.00 Median $2.14 Typical High $2.51 | Professional | None | $2.00 | $2.14 | $2.51 |
Hally Health Setting Professional Modifier None Typical Low $1.41 Median $2.09 Typical High $4.07 | Professional | None | $1.41 | $2.09 | $4.07 |
Medica Setting Facility Modifier None Typical Low $1.70 Median $1.95 Typical High $2.95 | Facility | None | $1.70 | $1.95 | $2.95 |
Medica Setting Professional Modifier None Typical Low $1.58 Median $1.82 Typical High $2.24 | Professional | None | $1.58 | $1.82 | $2.24 |
Midlands Setting Professional Modifier None Typical Low $1.86 Median $2.14 Typical High $2.57 | Professional | None | $1.86 | $2.14 | $2.57 |
Midlands Setting Professional Modifier None Typical Low $1.82 Median $1.86 Typical High $3.09 | Professional | None | $1.82 | $1.86 | $3.09 |
Oscar Health Setting Professional Modifier None Typical Low $1.91 Median $3.16 Typical High $4.17 | Professional | None | $1.91 | $3.16 | $4.17 |
United Setting Professional Modifier None Typical Low $1.78 Median $1.86 Typical High $2.09 | Professional | None | $1.78 | $1.86 | $2.09 |
Wellmark Setting Facility Modifier None Typical Low $1.95 Median $1.95 Typical High $1.95 | Facility | None | $1.95 | $1.95 | $1.95 |
Wellmark Setting Professional Modifier None Typical Low $1.95 Median $1.95 Typical High $1.95 | Professional | None | $1.95 | $1.95 | $1.95 |
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 $0.89 Median $0.89 Typical High $1.35 | Facility | 52 · Reduced service | $0.89 | $0.89 | $1.35 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.35 Median $0.35 Typical High $0.52 | Facility | 53 · Discontinued | $0.35 | $0.35 | $0.52 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.27 Median $0.27 Typical High $0.40 | Facility | 55 · Aftercare only | $0.27 | $0.27 | $0.40 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.18 Median $0.18 Typical High $0.27 | Facility | 56 · Pre-op care only | $0.18 | $0.18 | $0.27 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.89 Median $1.00 Typical High $1.00 | Professional | 52 · Reduced service | $0.89 | $1.00 | $1.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.35 Median $0.40 Typical High $0.40 | Professional | 53 · Discontinued | $0.35 | $0.40 | $0.40 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.27 Median $0.30 Typical High $0.30 | Professional | 55 · Aftercare only | $0.27 | $0.30 | $0.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.18 Median $0.20 Typical High $0.20 | Professional | 56 · Pre-op care only | $0.18 | $0.20 | $0.20 |
Where Iowa sits
Rates are fairly even across states for this service. 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· 48th of 51
$1.95
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.