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 $1.32 Median $1.32 Typical High $5.13 | Facility | None | $1.32 | $1.32 | $5.13 |
Aetna Setting Professional Modifier None Typical Low $1.32 Median $1.32 Typical High $5.13 | Professional | None | $1.32 | $1.32 | $5.13 |
Cigna Setting Professional Modifier None Typical Low $1.32 Median $1.62 Typical High $2.00 | Professional | None | $1.32 | $1.62 | $2.00 |
Medica Setting Facility Modifier None Typical Low $1.91 Median $2.24 Typical High $5.13 | Facility | None | $1.91 | $2.24 | $5.13 |
Medica Setting Professional Modifier None Typical Low $1.32 Median $1.48 Typical High $2.00 | Professional | None | $1.32 | $1.48 | $2.00 |
Midlands Setting Professional Modifier None Typical Low $1.58 Median $2.00 Typical High $2.00 | Professional | None | $1.58 | $2.00 | $2.00 |
Midlands Setting Professional Modifier None Typical Low $0.72 Median $0.72 Typical High $0.72 | Professional | None | $0.72 | $0.72 | $0.72 |
Sanford Health Plan Setting Professional Modifier None Typical Low $1.45 Median $1.45 Typical High $1.45 | Professional | None | $1.45 | $1.45 | $1.45 |
United Setting Professional Modifier None Typical Low $1.32 Median $1.41 Typical High $1.58 | Professional | None | $1.32 | $1.41 | $1.58 |
Wellmark Setting Facility Modifier None Typical Low $1.45 Median $1.45 Typical High $1.45 | Facility | None | $1.45 | $1.45 | $1.45 |
Wellmark Setting Professional Modifier None Typical Low $1.45 Median $1.45 Typical High $1.45 | Professional | None | $1.45 | $1.45 | $1.45 |
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 $0.66 Median $0.66 Typical High $2.51 | Professional | 52 · Reduced service | $0.66 | $0.66 | $2.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.26 Median $0.26 Typical High $1.02 | Professional | 53 · Discontinued | $0.26 | $0.26 | $1.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.20 Median $0.20 Typical High $0.78 | Professional | 55 · Aftercare only | $0.20 | $0.20 | $0.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.13 Median $0.13 Typical High $0.51 | Professional | 56 · Pre-op care only | $0.13 | $0.13 | $0.51 |
Where South Dakota sits
The same service costs 1.9 times more in Wyoming than in Florida. 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
$1.48
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.