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 $18.20 Median $18.20 Typical High $18.20 | Facility | None | $18.20 | $18.20 | $18.20 |
Aetna Setting Professional Modifier None Typical Low $16.98 Median $16.98 Typical High $18.62 | Professional | None | $16.98 | $16.98 | $18.62 |
Cigna Setting Facility Modifier None Typical Low $38.90 Median $38.90 Typical High $47.86 | Facility | None | $38.90 | $38.90 | $47.86 |
Cigna Setting Professional Modifier None Typical Low $27.54 Median $28.84 Typical High $36.31 | Professional | None | $27.54 | $28.84 | $36.31 |
Medica Setting Facility Modifier None Typical Low $22.39 Median $28.84 Typical High $33.11 | Facility | None | $22.39 | $28.84 | $33.11 |
Medica Setting Professional Modifier None Typical Low $10.00 Median $12.59 Typical High $199.53 | Professional | None | $10.00 | $12.59 | $199.53 |
Midlands Setting Professional Modifier None Typical Low $27.54 Median $27.54 Typical High $27.54 | Professional | None | $27.54 | $27.54 | $27.54 |
Midlands Setting Professional Modifier None Typical Low $22.91 Median $22.91 Typical High $44.67 | Professional | None | $22.91 | $22.91 | $44.67 |
Sanford Health Plan Setting Professional Modifier None Typical Low $21.38 Median $25.12 Typical High $31.62 | Professional | None | $21.38 | $25.12 | $31.62 |
United Setting Professional Modifier None Typical Low $8.32 Median $10.00 Typical High $20.89 | Professional | None | $8.32 | $10.00 | $20.89 |
Wellmark Setting Professional Modifier None Typical Low $20.42 Median $20.42 Typical High $20.42 | Professional | None | $20.42 | $20.42 | $20.42 |
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 $8.51 Median $8.51 Typical High $9.33 | Professional | 52 · Reduced service | $8.51 | $8.51 | $9.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.39 Median $3.39 Typical High $3.72 | Professional | 53 · Discontinued | $3.39 | $3.39 | $3.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $12.88 Median $12.88 Typical High $13.80 | Professional | 54 · Surgery only | $12.88 | $12.88 | $13.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.57 Median $2.57 Typical High $2.75 | Professional | 55 · Aftercare only | $2.57 | $2.57 | $2.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.70 Median $1.70 Typical High $1.86 | Professional | 56 · Pre-op care only | $1.70 | $1.70 | $1.86 |
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
$21.38
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.