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 $1.29 Median $1.29 Typical High $1.29 | Facility | None | $1.29 | $1.29 | $1.29 |
Aetna Setting Professional Modifier None Typical Low $1.20 Median $1.20 Typical High $1.29 | Professional | None | $1.20 | $1.20 | $1.29 |
Cigna Setting Facility Modifier None Typical Low $2.51 Median $2.51 Typical High $3.16 | Facility | None | $2.51 | $2.51 | $3.16 |
Cigna Setting Professional Modifier None Typical Low $1.86 Median $1.95 Typical High $2.34 | Professional | None | $1.86 | $1.95 | $2.34 |
Medica Setting Facility Modifier None Typical Low $1.23 Median $2.04 Typical High $2.04 | Facility | None | $1.23 | $2.04 | $2.04 |
Medica Setting Professional Modifier None Typical Low $0.71 Median $0.87 Typical High $8.71 | Professional | None | $0.71 | $0.87 | $8.71 |
Midlands Setting Professional Modifier None Typical Low $1.95 Median $1.95 Typical High $1.95 | Professional | None | $1.95 | $1.95 | $1.95 |
Midlands Setting Professional Modifier None Typical Low $1.62 Median $1.62 Typical High $3.16 | Professional | None | $1.62 | $1.62 | $3.16 |
Sanford Health Plan Setting Professional Modifier None Typical Low $1.66 Median $1.74 Typical High $2.34 | Professional | None | $1.66 | $1.74 | $2.34 |
United Setting Professional Modifier None Typical Low $0.58 Median $0.71 Typical High $1.48 | Professional | None | $0.58 | $0.71 | $1.48 |
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 $0.60 Median $0.60 Typical High $0.65 | Professional | 52 · Reduced service | $0.60 | $0.60 | $0.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.24 Median $0.24 Typical High $0.26 | Professional | 53 · Discontinued | $0.24 | $0.24 | $0.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.18 Median $0.18 Typical High $0.20 | Professional | 55 · Aftercare only | $0.18 | $0.18 | $0.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.12 Median $0.12 Typical High $0.13 | Professional | 56 · Pre-op care only | $0.12 | $0.12 | $0.13 |
Where South Dakota sits
The same service costs 2.5 times more in Idaho than in Colorado. 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· 14th 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.