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 $26.30 Median $26.30 Typical High $26.30 | Facility | None | $26.30 | $26.30 | $26.30 |
Aetna Setting Professional Modifier None Typical Low $25.12 Median $25.12 Typical High $66.07 | Professional | None | $25.12 | $25.12 | $66.07 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $56.23 Typical High $70.79 | Facility | None | $56.23 | $56.23 | $70.79 |
Cigna Setting Professional Modifier None Typical Low $39.81 Median $42.66 Typical High $52.48 | Professional | None | $39.81 | $42.66 | $52.48 |
Medica Setting Facility Modifier None Typical Low $41.69 Median $41.69 Typical High $52.48 | Facility | None | $41.69 | $41.69 | $52.48 |
Medica Setting Professional Modifier None Typical Low $14.45 Median $18.20 Typical High $457.09 | Professional | None | $14.45 | $18.20 | $457.09 |
Midlands Setting Professional Modifier None Typical Low $39.81 Median $39.81 Typical High $39.81 | Professional | None | $39.81 | $39.81 | $39.81 |
Midlands Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $66.07 | Professional | None | $33.11 | $33.11 | $66.07 |
Sanford Health Plan Setting Professional Modifier None Typical Low $30.90 Median $36.31 Typical High $45.71 | Professional | None | $30.90 | $36.31 | $45.71 |
United Setting Professional Modifier None Typical Low $12.02 Median $14.45 Typical High $30.20 | Professional | None | $12.02 | $14.45 | $30.20 |
Wellmark Setting Professional Modifier None Typical Low $29.51 Median $29.51 Typical High $29.51 | Professional | None | $29.51 | $29.51 | $29.51 |
5 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 $12.59 Median $12.59 Typical High $13.49 | Professional | 52 · Reduced service | $12.59 | $12.59 | $13.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.01 Median $5.01 Typical High $5.37 | Professional | 53 · Discontinued | $5.01 | $5.01 | $5.37 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $18.62 Median $18.62 Typical High $20.42 | Professional | 54 · Surgery only | $18.62 | $18.62 | $20.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.72 Median $3.72 Typical High $4.07 | Professional | 55 · Aftercare only | $3.72 | $3.72 | $4.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.51 Median $2.51 Typical High $2.69 | Professional | 56 · Pre-op care only | $2.51 | $2.51 | $2.69 |
Where South Dakota sits
The same service costs 3.1 times more in Rhode Island than in New York. 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· 16th of 51
$31.62
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.