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 $30.90 Median $30.90 Typical High $30.90 | Facility | None | $30.90 | $30.90 | $30.90 |
Aetna Setting Professional Modifier None Typical Low $26.30 Median $28.84 Typical High $31.62 | Professional | None | $26.30 | $28.84 | $31.62 |
Cigna Setting Facility Modifier None Typical Low $66.07 Median $66.07 Typical High $83.18 | Facility | None | $66.07 | $66.07 | $83.18 |
Cigna Setting Professional Modifier None Typical Low $46.77 Median $48.98 Typical High $61.66 | Professional | None | $46.77 | $48.98 | $61.66 |
Medica Setting Facility Modifier None Typical Low $47.86 Median $48.98 Typical High $57.54 | Facility | None | $47.86 | $48.98 | $57.54 |
Medica Setting Professional Modifier None Typical Low $16.98 Median $21.38 Typical High $416.87 | Professional | None | $16.98 | $21.38 | $416.87 |
Midlands Setting Professional Modifier None Typical Low $46.77 Median $46.77 Typical High $46.77 | Professional | None | $46.77 | $46.77 | $46.77 |
Midlands Setting Professional Modifier None Typical Low $38.90 Median $38.90 Typical High $75.86 | Professional | None | $38.90 | $38.90 | $75.86 |
Sanford Health Plan Setting Professional Modifier None Typical Low $36.31 Median $42.66 Typical High $53.70 | Professional | None | $36.31 | $42.66 | $53.70 |
United Setting Professional Modifier None Typical Low $14.13 Median $16.98 Typical High $35.48 | Professional | None | $14.13 | $16.98 | $35.48 |
Wellmark Setting Professional Modifier None Typical Low $34.67 Median $34.67 Typical High $34.67 | Professional | None | $34.67 | $34.67 | $34.67 |
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 $15.85 | Professional | 52 · Reduced service | $14.45 | $14.45 | $15.85 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.89 Median $5.89 Typical High $6.31 | Professional | 53 · Discontinued | $5.89 | $5.89 | $6.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $21.88 Median $21.88 Typical High $23.44 | Professional | 54 · Surgery only | $21.88 | $21.88 | $23.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.37 Median $4.37 Typical High $4.68 | Professional | 55 · Aftercare only | $4.37 | $4.37 | $4.68 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.95 Median $2.95 Typical High $3.16 | Professional | 56 · Pre-op care only | $2.95 | $2.95 | $3.16 |
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· 14th of 51
$36.31
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.