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 $53.70 Median $53.70 Typical High $53.70 | Facility | None | $53.70 | $53.70 | $53.70 |
Aetna Setting Professional Modifier None Typical Low $50.12 Median $50.12 Typical High $54.95 | Professional | None | $50.12 | $50.12 | $54.95 |
Cigna Setting Facility Modifier None Typical Low $114.82 Median $114.82 Typical High $141.25 | Facility | None | $114.82 | $114.82 | $141.25 |
Cigna Setting Professional Modifier None Typical Low $81.28 Median $85.11 Typical High $107.15 | Professional | None | $81.28 | $85.11 | $107.15 |
Medica Setting Facility Modifier None Typical Low $74.13 Median $85.11 Typical High $97.72 | Facility | None | $74.13 | $85.11 | $97.72 |
Medica Setting Professional Modifier None Typical Low $29.51 Median $37.15 Typical High $645.65 | Professional | None | $29.51 | $37.15 | $645.65 |
Midlands Setting Professional Modifier None Typical Low $81.28 Median $81.28 Typical High $81.28 | Professional | None | $81.28 | $81.28 | $81.28 |
Midlands Setting Professional Modifier None Typical Low $67.61 Median $67.61 Typical High $131.83 | Professional | None | $67.61 | $67.61 | $131.83 |
Sanford Health Plan Setting Professional Modifier None Typical Low $63.10 Median $74.13 Typical High $93.33 | Professional | None | $63.10 | $74.13 | $93.33 |
United Setting Professional Modifier None Typical Low $24.55 Median $29.51 Typical High $61.66 | Professional | None | $24.55 | $29.51 | $61.66 |
Wellmark Setting Professional Modifier None Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | None | $60.26 | $60.26 | $60.26 |
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 $25.12 Median $25.12 Typical High $27.54 | Professional | 52 · Reduced service | $25.12 | $25.12 | $27.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.00 Median $10.00 Typical High $10.96 | Professional | 53 · Discontinued | $10.00 | $10.00 | $10.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $38.02 Typical High $40.74 | Professional | 54 · Surgery only | $38.02 | $38.02 | $40.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $7.59 Typical High $8.13 | Professional | 55 · Aftercare only | $7.59 | $7.59 | $8.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.01 Median $5.01 Typical High $5.50 | Professional | 56 · Pre-op care only | $5.01 | $5.01 | $5.50 |
Where South Dakota sits
The same service costs 2.8 times more in Hawaii 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
$63.10
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.