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 $6.17 Median $6.17 Typical High $6.17 | Facility | None | $6.17 | $6.17 | $6.17 |
Aetna Setting Professional Modifier None Typical Low $5.75 Median $5.75 Typical High $7.59 | Professional | None | $5.75 | $5.75 | $7.59 |
Cigna Setting Facility Modifier None Typical Low $12.88 Median $12.88 Typical High $16.22 | Facility | None | $12.88 | $12.88 | $16.22 |
Cigna Setting Professional Modifier None Typical Low $9.33 Median $9.77 Typical High $12.30 | Professional | None | $9.33 | $9.77 | $12.30 |
Medica Setting Facility Modifier None Typical Low $9.77 Median $9.77 Typical High $15.85 | Facility | None | $9.77 | $9.77 | $15.85 |
Medica Setting Professional Modifier None Typical Low $3.39 Median $4.17 Typical High $138.04 | Professional | None | $3.39 | $4.17 | $138.04 |
Midlands Setting Professional Modifier None Typical Low $9.33 Median $9.33 Typical High $9.33 | Professional | None | $9.33 | $9.33 | $9.33 |
Midlands Setting Professional Modifier None Typical Low $7.76 Median $7.76 Typical High $15.14 | Professional | None | $7.76 | $7.76 | $15.14 |
Sanford Health Plan Setting Professional Modifier None Typical Low $7.24 Median $8.51 Typical High $10.47 | Professional | None | $7.24 | $8.51 | $10.47 |
United Setting Professional Modifier None Typical Low $2.82 Median $3.39 Typical High $7.08 | Professional | None | $2.82 | $3.39 | $7.08 |
Wellmark Setting Professional Modifier None Typical Low $6.92 Median $6.92 Typical High $6.92 | Professional | None | $6.92 | $6.92 | $6.92 |
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 $2.88 Median $2.88 Typical High $3.09 | Professional | 52 · Reduced service | $2.88 | $2.88 | $3.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.15 Median $1.15 Typical High $1.26 | Professional | 53 · Discontinued | $1.15 | $1.15 | $1.26 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $4.27 Median $4.27 Typical High $4.68 | Professional | 54 · Surgery only | $4.27 | $4.27 | $4.68 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.85 Median $0.85 Typical High $0.93 | Professional | 55 · Aftercare only | $0.85 | $0.85 | $0.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.58 Median $0.58 Typical High $0.62 | Professional | 56 · Pre-op care only | $0.58 | $0.58 | $0.62 |
Where South Dakota sits
The same service costs 4.1 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· 15th of 51
$7.24
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.