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 $4.17 Median $4.17 Typical High $4.17 | Facility | None | $4.17 | $4.17 | $4.17 |
Aetna Setting Professional Modifier None Typical Low $3.89 Median $3.89 Typical High $5.62 | Professional | None | $3.89 | $3.89 | $5.62 |
Cigna Setting Facility Modifier None Typical Low $8.91 Median $8.91 Typical High $11.22 | Facility | None | $8.91 | $8.91 | $11.22 |
Cigna Setting Professional Modifier None Typical Low $6.31 Median $6.76 Typical High $8.51 | Professional | None | $6.31 | $6.76 | $8.51 |
Medica Setting Facility Modifier None Typical Low $6.61 Median $6.61 Typical High $7.76 | Facility | None | $6.61 | $6.61 | $7.76 |
Medica Setting Professional Modifier None Typical Low $2.29 Median $2.82 Typical High $69.18 | Professional | None | $2.29 | $2.82 | $69.18 |
Midlands Setting Professional Modifier None Typical Low $6.31 Median $6.31 Typical High $6.31 | Professional | None | $6.31 | $6.31 | $6.31 |
Midlands Setting Professional Modifier None Typical Low $5.25 Median $5.25 Typical High $10.23 | Professional | None | $5.25 | $5.25 | $10.23 |
Sanford Health Plan Setting Professional Modifier None Typical Low $4.90 Median $5.75 Typical High $7.08 | Professional | None | $4.90 | $5.75 | $7.08 |
United Setting Professional Modifier None Typical Low $1.91 Median $2.29 Typical High $4.79 | Professional | None | $1.91 | $2.29 | $4.79 |
Wellmark Setting Professional Modifier None Typical Low $4.68 Median $4.68 Typical High $4.68 | Professional | None | $4.68 | $4.68 | $4.68 |
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 $1.95 Median $1.95 Typical High $2.09 | Professional | 52 · Reduced service | $1.95 | $1.95 | $2.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.78 Median $0.78 Typical High $0.83 | Professional | 53 · Discontinued | $0.78 | $0.78 | $0.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.95 Median $2.95 Typical High $3.16 | Professional | 54 · Surgery only | $2.95 | $2.95 | $3.16 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.58 Median $0.58 Typical High $0.63 | Professional | 55 · Aftercare only | $0.58 | $0.58 | $0.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.39 Median $0.39 Typical High $0.42 | Professional | 56 · Pre-op care only | $0.39 | $0.39 | $0.42 |
Where South Dakota sits
The same service costs 3.0 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· 14th of 51
$4.90
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.