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 $37.15 Median $37.15 Typical High $37.15 | Facility | None | $37.15 | $37.15 | $37.15 |
Aetna Setting Professional Modifier None Typical Low $34.67 Median $35.48 Typical High $47.86 | Professional | None | $34.67 | $35.48 | $47.86 |
Cigna Setting Facility Modifier None Typical Low $79.43 Median $79.43 Typical High $100.00 | Facility | None | $79.43 | $79.43 | $100.00 |
Cigna Setting Professional Modifier None Typical Low $56.23 Median $60.26 Typical High $74.13 | Professional | None | $56.23 | $60.26 | $74.13 |
Medica Setting Facility Modifier None Typical Low $58.88 Median $58.88 Typical High $83.18 | Facility | None | $58.88 | $58.88 | $83.18 |
Medica Setting Professional Modifier None Typical Low $20.42 Median $25.70 Typical High $724.44 | Professional | None | $20.42 | $25.70 | $724.44 |
Midlands Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $56.23 | Professional | None | $56.23 | $56.23 | $56.23 |
Midlands Setting Professional Modifier None Typical Low $46.77 Median $46.77 Typical High $91.20 | Professional | None | $46.77 | $46.77 | $91.20 |
Sanford Health Plan Setting Professional Modifier None Typical Low $43.65 Median $51.29 Typical High $64.57 | Professional | None | $43.65 | $51.29 | $64.57 |
United Setting Professional Modifier None Typical Low $16.98 Median $20.42 Typical High $42.66 | Professional | None | $16.98 | $20.42 | $42.66 |
Wellmark Setting Professional Modifier None Typical Low $41.69 Median $41.69 Typical High $41.69 | Professional | None | $41.69 | $41.69 | $41.69 |
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 $17.78 Median $17.78 Typical High $19.05 | Professional | 52 · Reduced service | $17.78 | $17.78 | $19.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.08 Median $7.08 Typical High $7.59 | Professional | 53 · Discontinued | $7.08 | $7.08 | $7.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $26.30 Median $26.30 Typical High $28.84 | Professional | 54 · Surgery only | $26.30 | $26.30 | $28.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.25 Median $5.25 Typical High $5.75 | Professional | 55 · Aftercare only | $5.25 | $5.25 | $5.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.55 Median $3.55 Typical High $3.80 | Professional | 56 · Pre-op care only | $3.55 | $3.55 | $3.80 |
Where South Dakota sits
The same service costs 2.6 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· 15th of 51
$42.66
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.