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 $10.96 Median $10.96 Typical High $10.96 | Facility | None | $10.96 | $10.96 | $10.96 |
Aetna Setting Professional Modifier None Typical Low $10.47 Median $10.47 Typical High $15.49 | Professional | None | $10.47 | $10.47 | $15.49 |
Cigna Setting Facility Modifier None Typical Low $23.44 Median $23.44 Typical High $29.51 | Facility | None | $23.44 | $23.44 | $29.51 |
Cigna Setting Professional Modifier None Typical Low $16.60 Median $17.78 Typical High $21.88 | Professional | None | $16.60 | $17.78 | $21.88 |
Medica Setting Facility Modifier None Typical Low $17.38 Median $17.38 Typical High $33.88 | Facility | None | $17.38 | $17.38 | $33.88 |
Medica Setting Professional Modifier None Typical Low $6.03 Median $7.59 Typical High $295.12 | Professional | None | $6.03 | $7.59 | $295.12 |
Midlands Setting Professional Modifier None Typical Low $16.60 Median $16.60 Typical High $16.60 | Professional | None | $16.60 | $16.60 | $16.60 |
Midlands Setting Professional Modifier None Typical Low $13.80 Median $13.80 Typical High $27.54 | Professional | None | $13.80 | $13.80 | $27.54 |
Sanford Health Plan Setting Professional Modifier None Typical Low $12.88 Median $15.14 Typical High $19.05 | Professional | None | $12.88 | $15.14 | $19.05 |
United Setting Professional Modifier None Typical Low $5.01 Median $6.03 Typical High $12.59 | Professional | None | $5.01 | $6.03 | $12.59 |
Wellmark Setting Professional Modifier None Typical Low $12.30 Median $12.30 Typical High $12.30 | Professional | None | $12.30 | $12.30 | $12.30 |
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 $5.25 Median $5.25 Typical High $5.62 | Professional | 52 · Reduced service | $5.25 | $5.25 | $5.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.09 Median $2.09 Typical High $2.24 | Professional | 53 · Discontinued | $2.09 | $2.09 | $2.24 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $7.76 Median $7.76 Typical High $8.51 | Professional | 54 · Surgery only | $7.76 | $7.76 | $8.51 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.55 Median $1.55 Typical High $1.70 | Professional | 55 · Aftercare only | $1.55 | $1.55 | $1.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.05 Median $1.05 Typical High $1.12 | Professional | 56 · Pre-op care only | $1.05 | $1.05 | $1.12 |
Where South Dakota sits
The same service costs 4.5 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· 17th of 51
$12.88
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.