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 $16.60 Median $32.36 Typical High $35.48 | Professional | None | $16.60 | $32.36 | $35.48 |
Cigna Setting Facility Modifier None Typical Low $74.13 Median $74.13 Typical High $91.20 | Facility | None | $74.13 | $74.13 | $91.20 |
Cigna Setting Professional Modifier None Typical Low $52.48 Median $54.95 Typical High $69.18 | Professional | None | $52.48 | $54.95 | $69.18 |
Medica Setting Facility Modifier None Typical Low $36.31 Median $54.95 Typical High $63.10 | Facility | None | $36.31 | $54.95 | $63.10 |
Medica Setting Professional Modifier None Typical Low $19.05 Median $23.44 Typical High $316.23 | Professional | None | $19.05 | $23.44 | $316.23 |
Midlands Setting Professional Modifier None Typical Low $52.48 Median $52.48 Typical High $52.48 | Professional | None | $52.48 | $52.48 | $52.48 |
Midlands Setting Professional Modifier None Typical Low $43.65 Median $43.65 Typical High $85.11 | Professional | None | $43.65 | $43.65 | $85.11 |
Sanford Health Plan Setting Professional Modifier None Typical Low $40.74 Median $47.86 Typical High $60.26 | Professional | None | $40.74 | $47.86 | $60.26 |
United Setting Professional Modifier None Typical Low $15.85 Median $19.05 Typical High $39.81 | Professional | None | $15.85 | $19.05 | $39.81 |
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 $7.08 | Professional | 53 · Discontinued | $6.46 | $6.46 | $7.08 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $24.55 Median $24.55 Typical High $26.30 | Professional | 54 · Surgery only | $24.55 | $24.55 | $26.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.90 Median $4.90 Typical High $5.25 | Professional | 55 · Aftercare only | $4.90 | $4.90 | $5.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.24 Median $3.24 Typical High $3.55 | Professional | 56 · Pre-op care only | $3.24 | $3.24 | $3.55 |
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· 13th of 51
$39.81
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.