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 $3.89 Median $3.89 Typical High $3.89 | Facility | None | $3.89 | $3.89 | $3.89 |
Aetna Setting Professional Modifier None Typical Low $3.72 Median $3.72 Typical High $4.57 | Professional | None | $3.72 | $3.72 | $4.57 |
Cigna Setting Facility Modifier None Typical Low $8.51 Median $8.51 Typical High $10.72 | Facility | None | $8.51 | $8.51 | $10.72 |
Cigna Setting Professional Modifier None Typical Low $5.89 Median $6.31 Typical High $7.94 | Professional | None | $5.89 | $6.31 | $7.94 |
Medica Setting Facility Modifier None Typical Low $6.17 Median $6.17 Typical High $9.55 | Facility | None | $6.17 | $6.17 | $9.55 |
Medica Setting Professional Modifier None Typical Low $2.14 Median $2.69 Typical High $83.18 | Professional | None | $2.14 | $2.69 | $83.18 |
Midlands Setting Professional Modifier None Typical Low $5.89 Median $5.89 Typical High $5.89 | Professional | None | $5.89 | $5.89 | $5.89 |
Midlands Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $9.55 | Professional | None | $4.90 | $4.90 | $9.55 |
Sanford Health Plan Setting Professional Modifier None Typical Low $4.57 Median $5.37 Typical High $6.76 | Professional | None | $4.57 | $5.37 | $6.76 |
United Setting Professional Modifier None Typical Low $1.78 Median $2.14 Typical High $4.47 | Professional | None | $1.78 | $2.14 | $4.47 |
Wellmark Setting Professional Modifier None Typical Low $4.37 Median $4.37 Typical High $4.37 | Professional | None | $4.37 | $4.37 | $4.37 |
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 $1.82 Median $1.82 Typical High $2.00 | Professional | 52 · Reduced service | $1.82 | $1.82 | $2.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.74 Median $0.74 Typical High $0.79 | Professional | 53 · Discontinued | $0.74 | $0.74 | $0.79 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.75 Median $2.75 Typical High $3.02 | Professional | 54 · Surgery only | $2.75 | $2.75 | $3.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.55 Median $0.55 Typical High $0.60 | Professional | 55 · Aftercare only | $0.55 | $0.55 | $0.60 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.37 Median $0.37 Typical High $0.40 | Professional | 56 · Pre-op care only | $0.37 | $0.37 | $0.40 |
Where South Dakota sits
The same service costs 3.8 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· 15th of 51
$4.57
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.