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 $13.18 Median $13.18 Typical High $13.18 | Facility | None | $13.18 | $13.18 | $13.18 |
Aetna Setting Professional Modifier None Typical Low $12.30 Median $12.30 Typical High $13.49 | Professional | None | $12.30 | $12.30 | $13.49 |
Cigna Setting Facility Modifier None Typical Low $28.18 Median $28.18 Typical High $34.67 | Facility | None | $28.18 | $28.18 | $34.67 |
Cigna Setting Professional Modifier None Typical Low $19.95 Median $20.89 Typical High $26.30 | Professional | None | $19.95 | $20.89 | $26.30 |
Medica Setting Facility Modifier None Typical Low $17.38 Median $20.89 Typical High $23.99 | Facility | None | $17.38 | $20.89 | $23.99 |
Medica Setting Professional Modifier None Typical Low $7.24 Median $8.91 Typical High $151.36 | Professional | None | $7.24 | $8.91 | $151.36 |
Midlands Setting Professional Modifier None Typical Low $19.95 Median $19.95 Typical High $19.95 | Professional | None | $19.95 | $19.95 | $19.95 |
Midlands Setting Professional Modifier None Typical Low $16.60 Median $16.60 Typical High $32.36 | Professional | None | $16.60 | $16.60 | $32.36 |
Sanford Health Plan Setting Professional Modifier None Typical Low $15.49 Median $18.20 Typical High $22.91 | Professional | None | $15.49 | $18.20 | $22.91 |
United Setting Professional Modifier None Typical Low $6.03 Median $7.24 Typical High $15.14 | Professional | None | $6.03 | $7.24 | $15.14 |
Wellmark Setting Professional Modifier None Typical Low $14.79 Median $14.79 Typical High $14.79 | Professional | None | $14.79 | $14.79 | $14.79 |
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 $6.17 Median $6.17 Typical High $6.61 | Professional | 52 · Reduced service | $6.17 | $6.17 | $6.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.45 Median $2.45 Typical High $2.69 | Professional | 53 · Discontinued | $2.45 | $2.45 | $2.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $9.33 Median $9.33 Typical High $10.00 | Professional | 54 · Surgery only | $9.33 | $9.33 | $10.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.86 Median $1.86 Typical High $2.00 | Professional | 55 · Aftercare only | $1.86 | $1.86 | $2.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.23 Median $1.23 Typical High $1.32 | Professional | 56 · Pre-op care only | $1.23 | $1.23 | $1.32 |
Where South Dakota sits
The same service costs 2.7 times more in Idaho 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· 13th of 51
$15.49
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.