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 $34.67 Median $34.67 Typical High $34.67 | Facility | None | $34.67 | $34.67 | $34.67 |
Aetna Setting Professional Modifier None Typical Low $32.36 Median $32.36 Typical High $34.67 | Professional | None | $32.36 | $32.36 | $34.67 |
Cigna Setting Facility Modifier None Typical Low $72.44 Median $72.44 Typical High $91.20 | Facility | None | $72.44 | $72.44 | $91.20 |
Cigna Setting Professional Modifier None Typical Low $51.29 Median $54.95 Typical High $69.18 | Professional | None | $51.29 | $54.95 | $69.18 |
Medica Setting Facility Modifier None Typical Low $54.95 Median $54.95 Typical High $69.18 | Facility | None | $54.95 | $54.95 | $69.18 |
Medica Setting Professional Modifier None Typical Low $18.62 Median $23.44 Typical High $616.60 | Professional | None | $18.62 | $23.44 | $616.60 |
Midlands Setting Professional Modifier None Typical Low $51.29 Median $51.29 Typical High $51.29 | Professional | None | $51.29 | $51.29 | $51.29 |
Midlands Setting Professional Modifier None Typical Low $42.66 Median $42.66 Typical High $85.11 | Professional | None | $42.66 | $42.66 | $85.11 |
Sanford Health Plan Setting Professional Modifier None Typical Low $40.74 Median $46.77 Typical High $58.88 | Professional | None | $40.74 | $46.77 | $58.88 |
United Setting Professional Modifier None Typical Low $15.49 Median $18.62 Typical High $38.90 | Professional | None | $15.49 | $18.62 | $38.90 |
Wellmark Setting Professional Modifier None Typical Low $38.90 Median $38.90 Typical High $38.90 | Professional | None | $38.90 | $38.90 | $38.90 |
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 $16.22 Median $16.22 Typical High $17.38 | Professional | 52 · Reduced service | $16.22 | $16.22 | $17.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.46 Median $6.46 Typical High $6.92 | Professional | 53 · Discontinued | $6.46 | $6.46 | $6.92 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $23.99 Median $23.99 Typical High $26.30 | Professional | 54 · Surgery only | $23.99 | $23.99 | $26.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.79 Median $4.79 Typical High $5.25 | Professional | 55 · Aftercare only | $4.79 | $4.79 | $5.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.24 Median $3.24 Typical High $3.47 | Professional | 56 · Pre-op care only | $3.24 | $3.24 | $3.47 |
Where South Dakota sits
The same service costs 3.2 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
$40.74
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.