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 $30.20 Median $30.20 Typical High $30.20 | Facility | None | $30.20 | $30.20 | $30.20 |
Aetna Setting Professional Modifier None Typical Low $14.13 Median $28.84 Typical High $30.90 | Professional | None | $14.13 | $28.84 | $30.90 |
Cigna Setting Facility Modifier None Typical Low $64.57 Median $64.57 Typical High $81.28 | Facility | None | $64.57 | $64.57 | $81.28 |
Cigna Setting Professional Modifier None Typical Low $45.71 Median $48.98 Typical High $60.26 | Professional | None | $45.71 | $48.98 | $60.26 |
Medica Setting Facility Modifier None Typical Low $30.90 Median $47.86 Typical High $56.23 | Facility | None | $30.90 | $47.86 | $56.23 |
Medica Setting Professional Modifier None Typical Low $16.60 Median $20.89 Typical High $269.15 | Professional | None | $16.60 | $20.89 | $269.15 |
Midlands Setting Professional Modifier None Typical Low $45.71 Median $45.71 Typical High $45.71 | Professional | None | $45.71 | $45.71 | $45.71 |
Midlands Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $75.86 | Professional | None | $38.02 | $38.02 | $75.86 |
Sanford Health Plan Setting Professional Modifier None Typical Low $35.48 Median $41.69 Typical High $52.48 | Professional | None | $35.48 | $41.69 | $52.48 |
United Setting Professional Modifier None Typical Low $13.80 Median $16.60 Typical High $34.67 | Professional | None | $13.80 | $16.60 | $34.67 |
Wellmark Setting Professional Modifier None Typical Low $33.88 Median $33.88 Typical High $33.88 | Professional | None | $33.88 | $33.88 | $33.88 |
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 $14.45 Median $14.45 Typical High $15.49 | Professional | 52 · Reduced service | $14.45 | $14.45 | $15.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.75 Median $5.75 Typical High $6.17 | Professional | 53 · Discontinued | $5.75 | $5.75 | $6.17 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $21.38 Median $21.38 Typical High $23.44 | Professional | 54 · Surgery only | $21.38 | $21.38 | $23.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.27 Median $4.27 Typical High $4.68 | Professional | 55 · Aftercare only | $4.27 | $4.27 | $4.68 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.88 Median $2.88 Typical High $3.09 | Professional | 56 · Pre-op care only | $2.88 | $2.88 | $3.09 |
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
$34.67
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.