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 $0.45 Median $0.45 Typical High $0.56 | Facility | None | $0.45 | $0.45 | $0.56 |
Aetna Setting Professional Modifier None Typical Low $0.45 Median $0.48 Typical High $0.56 | Professional | None | $0.45 | $0.48 | $0.56 |
Cigna Setting Professional Modifier None Typical Low $0.76 Median $0.93 Typical High $1.10 | Professional | None | $0.76 | $0.93 | $1.10 |
Medica Setting Facility Modifier None Typical Low $0.56 Median $0.85 Typical High $1.38 | Facility | None | $0.56 | $0.85 | $1.38 |
Medica Setting Professional Modifier None Typical Low $0.47 Median $0.52 Typical High $218.78 | Professional | None | $0.47 | $0.52 | $218.78 |
Midlands Setting Professional Modifier None Typical Low $1.10 Median $1.10 Typical High $1.10 | Professional | None | $1.10 | $1.10 | $1.10 |
Midlands Setting Professional Modifier None Typical Low $1.15 Median $1.15 Typical High $1.15 | Professional | None | $1.15 | $1.15 | $1.15 |
Sanford Health Plan Setting Professional Modifier None Typical Low $2.04 Median $2.04 Typical High $2.04 | Professional | None | $2.04 | $2.04 | $2.04 |
United Setting Professional Modifier None Typical Low $0.47 Median $0.47 Typical High $0.52 | Professional | None | $0.47 | $0.47 | $0.52 |
Wellmark Setting Facility Modifier None Typical Low $0.47 Median $0.47 Typical High $0.47 | Facility | None | $0.47 | $0.47 | $0.47 |
Wellmark Setting Professional Modifier None Typical Low $0.47 Median $0.47 Typical High $0.47 | Professional | None | $0.47 | $0.47 | $0.47 |
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 $0.23 Median $0.24 Typical High $0.28 | Professional | 52 · Reduced service | $0.23 | $0.24 | $0.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.09 Median $0.10 Typical High $0.11 | Professional | 53 · Discontinued | $0.09 | $0.10 | $0.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.07 Median $0.07 Typical High $0.08 | Professional | 55 · Aftercare only | $0.07 | $0.07 | $0.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.05 Median $0.05 Typical High $0.06 | Professional | 56 · Pre-op care only | $0.05 | $0.05 | $0.06 |
Where South Dakota sits
The same service costs 2.3 times more in Montana than in Michigan. 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· 5th of 51
$0.56
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.