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 $24.55 Median $24.55 Typical High $24.55 | Facility | None | $24.55 | $24.55 | $24.55 |
Aetna Setting Professional Modifier None Typical Low $22.91 Median $22.91 Typical High $25.12 | Professional | None | $22.91 | $22.91 | $25.12 |
Cigna Setting Facility Modifier None Typical Low $52.48 Median $52.48 Typical High $64.57 | Facility | None | $52.48 | $52.48 | $64.57 |
Cigna Setting Professional Modifier None Typical Low $37.15 Median $38.90 Typical High $48.98 | Professional | None | $37.15 | $38.90 | $48.98 |
Medica Setting Facility Modifier None Typical Low $29.51 Median $38.90 Typical High $44.67 | Facility | None | $29.51 | $38.90 | $44.67 |
Medica Setting Professional Modifier None Typical Low $13.49 Median $16.98 Typical High $257.04 | Professional | None | $13.49 | $16.98 | $257.04 |
Midlands Setting Professional Modifier None Typical Low $37.15 Median $37.15 Typical High $37.15 | Professional | None | $37.15 | $37.15 | $37.15 |
Midlands Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $60.26 | Professional | None | $30.90 | $30.90 | $60.26 |
Sanford Health Plan Setting Professional Modifier None Typical Low $28.84 Median $33.88 Typical High $42.66 | Professional | None | $28.84 | $33.88 | $42.66 |
United Setting Professional Modifier None Typical Low $11.22 Median $13.49 Typical High $28.18 | Professional | None | $11.22 | $13.49 | $28.18 |
Wellmark Setting Professional Modifier None Typical Low $27.54 Median $27.54 Typical High $27.54 | Professional | None | $27.54 | $27.54 | $27.54 |
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 $11.48 Median $11.48 Typical High $12.59 | Professional | 52 · Reduced service | $11.48 | $11.48 | $12.59 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.57 Median $4.57 Typical High $5.01 | Professional | 53 · Discontinued | $4.57 | $4.57 | $5.01 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $17.38 Median $17.38 Typical High $18.62 | Professional | 54 · Surgery only | $17.38 | $17.38 | $18.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.47 Median $3.47 Typical High $3.72 | Professional | 55 · Aftercare only | $3.47 | $3.47 | $3.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.29 Median $2.29 Typical High $2.51 | Professional | 56 · Pre-op care only | $2.29 | $2.29 | $2.51 |
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· 12th of 51
$28.84
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.