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 $60.26 Median $60.26 Typical High $60.26 | Facility | None | $60.26 | $60.26 | $60.26 |
Aetna Setting Professional Modifier None Typical Low $57.54 Median $57.54 Typical High $61.66 | Professional | None | $57.54 | $57.54 | $61.66 |
Cigna Setting Facility Modifier None Typical Low $128.82 Median $128.82 Typical High $162.18 | Facility | None | $128.82 | $128.82 | $162.18 |
Cigna Setting Professional Modifier None Typical Low $91.20 Median $97.72 Typical High $120.23 | Professional | None | $91.20 | $97.72 | $120.23 |
Medica Setting Facility Modifier None Typical Low $61.66 Median $97.72 Typical High $112.20 | Facility | None | $61.66 | $97.72 | $112.20 |
Medica Setting Professional Modifier None Typical Low $33.11 Median $41.69 Typical High $549.54 | Professional | None | $33.11 | $41.69 | $549.54 |
Midlands Setting Professional Modifier None Typical Low $91.20 Median $91.20 Typical High $91.20 | Professional | None | $91.20 | $91.20 | $91.20 |
Midlands Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $151.36 | Professional | None | $75.86 | $75.86 | $151.36 |
Sanford Health Plan Setting Professional Modifier None Typical Low $70.79 Median $83.18 Typical High $104.71 | Professional | None | $70.79 | $83.18 | $104.71 |
United Setting Professional Modifier None Typical Low $27.54 Median $33.11 Typical High $69.18 | Professional | None | $27.54 | $33.11 | $69.18 |
Wellmark Setting Professional Modifier None Typical Low $67.61 Median $67.61 Typical High $67.61 | Professional | None | $67.61 | $67.61 | $67.61 |
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 $28.84 Median $28.84 Typical High $30.90 | Professional | 52 · Reduced service | $28.84 | $28.84 | $30.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $11.48 Typical High $12.30 | Professional | 53 · Discontinued | $11.48 | $11.48 | $12.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $42.66 Median $42.66 Typical High $46.77 | Professional | 54 · Surgery only | $42.66 | $42.66 | $46.77 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $8.51 Typical High $9.33 | Professional | 55 · Aftercare only | $8.51 | $8.51 | $9.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $5.75 Typical High $6.17 | Professional | 56 · Pre-op care only | $5.75 | $5.75 | $6.17 |
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
$70.79
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.