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 $3.09 Median $3.09 Typical High $3.09 | Facility | None | $3.09 | $3.09 | $3.09 |
Aetna Setting Professional Modifier None Typical Low $2.88 Median $2.88 Typical High $4.17 | Professional | None | $2.88 | $2.88 | $4.17 |
Cigna Setting Facility Modifier None Typical Low $6.46 Median $6.46 Typical High $8.13 | Facility | None | $6.46 | $6.46 | $8.13 |
Cigna Setting Professional Modifier None Typical Low $4.68 Median $4.90 Typical High $6.03 | Professional | None | $4.68 | $4.90 | $6.03 |
Medica Setting Facility Modifier None Typical Low $4.90 Median $4.90 Typical High $7.76 | Facility | None | $4.90 | $4.90 | $7.76 |
Medica Setting Professional Modifier None Typical Low $1.70 Median $2.09 Typical High $69.18 | Professional | None | $1.70 | $2.09 | $69.18 |
Midlands Setting Professional Modifier None Typical Low $4.68 Median $4.68 Typical High $4.68 | Professional | None | $4.68 | $4.68 | $4.68 |
Midlands Setting Professional Modifier None Typical Low $3.89 Median $3.89 Typical High $7.59 | Professional | None | $3.89 | $3.89 | $7.59 |
Sanford Health Plan Setting Professional Modifier None Typical Low $3.63 Median $4.27 Typical High $5.37 | Professional | None | $3.63 | $4.27 | $5.37 |
United Setting Professional Modifier None Typical Low $1.41 Median $1.70 Typical High $3.55 | Professional | None | $1.41 | $1.70 | $3.55 |
Wellmark Setting Professional Modifier None Typical Low $3.47 Median $3.47 Typical High $3.47 | Professional | None | $3.47 | $3.47 | $3.47 |
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 $1.45 Median $1.45 Typical High $1.58 | Professional | 52 · Reduced service | $1.45 | $1.45 | $1.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.58 Median $0.58 Typical High $0.63 | Professional | 53 · Discontinued | $0.58 | $0.58 | $0.63 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.19 Median $2.19 Typical High $2.34 | Professional | 54 · Surgery only | $2.19 | $2.19 | $2.34 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.43 Median $0.43 Typical High $0.47 | Professional | 55 · Aftercare only | $0.43 | $0.43 | $0.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.28 Median $0.28 Typical High $0.31 | Professional | 56 · Pre-op care only | $0.28 | $0.28 | $0.31 |
Where South Dakota sits
The same service costs 4.0 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
$3.63
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.