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 $23.99 Median $23.99 Typical High $23.99 | Facility | None | $23.99 | $23.99 | $23.99 |
Aetna Setting Professional Modifier None Typical Low $17.38 Median $22.91 Typical High $25.12 | Professional | None | $17.38 | $22.91 | $25.12 |
Cigna Setting Facility Modifier None Typical Low $51.29 Median $51.29 Typical High $64.57 | Facility | None | $51.29 | $51.29 | $64.57 |
Cigna Setting Professional Modifier None Typical Low $36.31 Median $38.90 Typical High $47.86 | Professional | None | $36.31 | $38.90 | $47.86 |
Medica Setting Facility Modifier None Typical Low $38.02 Median $38.02 Typical High $44.67 | Facility | None | $38.02 | $38.02 | $44.67 |
Medica Setting Professional Modifier None Typical Low $13.18 Median $16.60 Typical High $338.84 | Professional | None | $13.18 | $16.60 | $338.84 |
Midlands Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $36.31 | Professional | None | $36.31 | $36.31 | $36.31 |
Midlands Setting Professional Modifier None Typical Low $30.20 Median $30.20 Typical High $58.88 | Professional | None | $30.20 | $30.20 | $58.88 |
Sanford Health Plan Setting Professional Modifier None Typical Low $28.18 Median $33.11 Typical High $41.69 | Professional | None | $28.18 | $33.11 | $41.69 |
United Setting Professional Modifier None Typical Low $10.96 Median $13.18 Typical High $27.54 | Professional | None | $10.96 | $13.18 | $27.54 |
Wellmark Setting Professional Modifier None Typical Low $26.92 Median $26.92 Typical High $26.92 | Professional | None | $26.92 | $26.92 | $26.92 |
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 $11.22 Median $11.22 Typical High $12.30 | Professional | 52 · Reduced service | $11.22 | $11.22 | $12.30 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.57 Median $4.57 Typical High $4.90 | Professional | 53 · Discontinued | $4.57 | $4.57 | $4.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $16.98 Median $16.98 Typical High $18.62 | Professional | 54 · Surgery only | $16.98 | $16.98 | $18.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.39 Median $3.39 Typical High $3.72 | Professional | 55 · Aftercare only | $3.39 | $3.39 | $3.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.29 Median $2.29 Typical High $2.45 | Professional | 56 · Pre-op care only | $2.29 | $2.29 | $2.45 |
Where South Dakota sits
The same service costs 2.6 times more in Hawaii 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
$27.54
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.