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 $0.11 Median $0.36 Typical High $0.36 | Facility | None | $0.11 | $0.36 | $0.36 |
Aetna Setting Professional Modifier None Typical Low $0.06 Median $0.06 Typical High $0.36 | Professional | None | $0.06 | $0.06 | $0.36 |
Cigna Setting Professional Modifier None Typical Low $0.05 Median $0.09 Typical High $0.10 | Professional | None | $0.05 | $0.09 | $0.10 |
Hally Health Setting Professional Modifier None Typical Low $0.07 Median $0.08 Typical High $9.55 | Professional | None | $0.07 | $0.08 | $9.55 |
Medica Setting Facility Modifier None Typical Low $0.08 Median $0.10 Typical High $1.00 | Facility | None | $0.08 | $0.10 | $1.00 |
Medica Setting Professional Modifier None Typical Low $0.06 Median $0.09 Typical High $2.69 | Professional | None | $0.06 | $0.09 | $2.69 |
Midlands Setting Professional Modifier None Typical Low $0.08 Median $0.09 Typical High $0.10 | Professional | None | $0.08 | $0.09 | $0.10 |
Midlands Setting Professional Modifier None Typical Low $0.08 Median $0.10 Typical High $0.41 | Professional | None | $0.08 | $0.10 | $0.41 |
Oscar Health Setting Professional Modifier None Typical Low $0.05 Median $0.10 Typical High $0.17 | Professional | None | $0.05 | $0.10 | $0.17 |
United Setting Professional Modifier None Typical Low $0.08 Median $0.08 Typical High $2.63 | Professional | None | $0.08 | $0.08 | $2.63 |
Wellmark Setting Facility Modifier None Typical Low $0.09 Median $0.09 Typical High $0.09 | Facility | None | $0.09 | $0.09 | $0.09 |
Wellmark Setting Professional Modifier None Typical Low $0.09 Median $0.09 Typical High $0.09 | Professional | None | $0.09 | $0.09 | $0.09 |
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 $0.04 Median $0.18 Typical High $0.18 | Facility | 52 · Reduced service | $0.04 | $0.18 | $0.18 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.02 Median $0.07 Typical High $0.07 | Facility | 53 · Discontinued | $0.02 | $0.07 | $0.07 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.02 Median $0.05 Typical High $0.05 | Facility | 55 · Aftercare only | $0.02 | $0.05 | $0.05 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.04 | Facility | 56 · Pre-op care only | $0.04 | $0.04 | $0.04 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.03 Median $0.03 Typical High $0.18 | Professional | 52 · Reduced service | $0.03 | $0.03 | $0.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.02 Median $0.07 Typical High $0.07 | Professional | 53 · Discontinued | $0.02 | $0.07 | $0.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.04 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $0.04 |
Where Iowa sits
The same service costs 8.5 times more in Wyoming than in New Jersey. 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· 5th of 51
$0.09
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.