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 $12.30 Median $12.30 Typical High $12.30 | Facility | None | $12.30 | $12.30 | $12.30 |
Aetna Setting Professional Modifier None Typical Low $11.48 Median $11.48 Typical High $12.59 | Professional | None | $11.48 | $11.48 | $12.59 |
Cigna Setting Facility Modifier None Typical Low $25.70 Median $25.70 Typical High $32.36 | Facility | None | $25.70 | $25.70 | $32.36 |
Cigna Setting Professional Modifier None Typical Low $18.62 Median $19.50 Typical High $24.55 | Professional | None | $18.62 | $19.50 | $24.55 |
Medica Setting Facility Modifier None Typical Low $14.79 Median $19.50 Typical High $22.39 | Facility | None | $14.79 | $19.50 | $22.39 |
Medica Setting Professional Modifier None Typical Low $6.76 Median $8.32 Typical High $125.89 | Professional | None | $6.76 | $8.32 | $125.89 |
Midlands Setting Professional Modifier None Typical Low $18.62 Median $18.62 Typical High $18.62 | Professional | None | $18.62 | $18.62 | $18.62 |
Midlands Setting Professional Modifier None Typical Low $15.49 Median $15.49 Typical High $30.20 | Professional | None | $15.49 | $15.49 | $30.20 |
Sanford Health Plan Setting Professional Modifier None Typical Low $14.45 Median $16.98 Typical High $21.38 | Professional | None | $14.45 | $16.98 | $21.38 |
United Setting Professional Modifier None Typical Low $5.62 Median $6.76 Typical High $14.13 | Professional | None | $5.62 | $6.76 | $14.13 |
Wellmark Setting Professional Modifier None Typical Low $13.80 Median $13.80 Typical High $13.80 | Professional | None | $13.80 | $13.80 | $13.80 |
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 $5.75 Median $5.75 Typical High $6.17 | Professional | 52 · Reduced service | $5.75 | $5.75 | $6.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.29 Median $2.29 Typical High $2.51 | Professional | 53 · Discontinued | $2.29 | $2.29 | $2.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $8.71 Median $8.71 Typical High $9.33 | Professional | 54 · Surgery only | $8.71 | $8.71 | $9.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.74 Median $1.74 Typical High $1.86 | Professional | 55 · Aftercare only | $1.74 | $1.74 | $1.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.15 Median $1.15 Typical High $1.26 | Professional | 56 · Pre-op care only | $1.15 | $1.15 | $1.26 |
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
$14.45
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.