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 $17.38 Median $17.38 Typical High $17.38 | Facility | None | $17.38 | $17.38 | $17.38 |
Aetna Setting Professional Modifier None Typical Low $16.22 Median $16.22 Typical High $17.38 | Professional | None | $16.22 | $16.22 | $17.38 |
Cigna Setting Facility Modifier None Typical Low $36.31 Median $36.31 Typical High $45.71 | Facility | None | $36.31 | $36.31 | $45.71 |
Cigna Setting Professional Modifier None Typical Low $25.70 Median $27.54 Typical High $33.88 | Professional | None | $25.70 | $27.54 | $33.88 |
Medica Setting Facility Modifier None Typical Low $27.54 Median $27.54 Typical High $34.67 | Facility | None | $27.54 | $27.54 | $34.67 |
Medica Setting Professional Modifier None Typical Low $9.33 Median $11.75 Typical High $309.03 | Professional | None | $9.33 | $11.75 | $309.03 |
Midlands Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | None | $25.70 | $25.70 | $25.70 |
Midlands Setting Professional Modifier None Typical Low $21.38 Median $21.38 Typical High $42.66 | Professional | None | $21.38 | $21.38 | $42.66 |
Sanford Health Plan Setting Professional Modifier None Typical Low $19.95 Median $23.44 Typical High $29.51 | Professional | None | $19.95 | $23.44 | $29.51 |
United Setting Professional Modifier None Typical Low $7.76 Median $9.33 Typical High $19.50 | Professional | None | $7.76 | $9.33 | $19.50 |
Wellmark Setting Professional Modifier None Typical Low $19.05 Median $19.05 Typical High $19.05 | Professional | None | $19.05 | $19.05 | $19.05 |
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 $8.13 Median $8.13 Typical High $8.71 | Professional | 52 · Reduced service | $8.13 | $8.13 | $8.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.24 Median $3.24 Typical High $3.47 | Professional | 53 · Discontinued | $3.24 | $3.24 | $3.47 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $12.02 Median $12.02 Typical High $13.18 | Professional | 54 · Surgery only | $12.02 | $12.02 | $13.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.40 Median $2.40 Typical High $2.63 | Professional | 55 · Aftercare only | $2.40 | $2.40 | $2.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.62 Median $1.62 Typical High $1.74 | Professional | 56 · Pre-op care only | $1.62 | $1.62 | $1.74 |
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· 15th of 51
$19.95
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.