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 $16.98 Median $16.98 Typical High $16.98 | Facility | None | $16.98 | $16.98 | $16.98 |
Aetna Setting Professional Modifier None Typical Low $14.13 Median $15.85 Typical High $17.78 | Professional | None | $14.13 | $15.85 | $17.78 |
Cigna Setting Facility Modifier None Typical Low $36.31 Median $36.31 Typical High $44.67 | Facility | None | $36.31 | $36.31 | $44.67 |
Cigna Setting Professional Modifier None Typical Low $25.70 Median $26.92 Typical High $33.88 | Professional | None | $25.70 | $26.92 | $33.88 |
Medica Setting Facility Modifier None Typical Low $26.92 Median $26.92 Typical High $30.90 | Facility | None | $26.92 | $26.92 | $30.90 |
Medica Setting Professional Modifier None Typical Low $9.33 Median $11.75 Typical High $269.15 | Professional | None | $9.33 | $11.75 | $269.15 |
Midlands Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | None | $25.70 | $25.70 | $25.70 |
Midlands Setting Professional Modifier None Typical Low $21.38 Median $21.38 Typical High $41.69 | Professional | None | $21.38 | $21.38 | $41.69 |
Sanford Health Plan Setting Professional Modifier None Typical Low $19.95 Median $23.44 Typical High $29.51 | Professional | None | $19.95 | $23.44 | $29.51 |
United Setting Professional Modifier None Typical Low $7.76 Median $9.33 Typical High $19.50 | Professional | None | $7.76 | $9.33 | $19.50 |
Wellmark Setting Professional Modifier None Typical Low $19.05 Median $19.05 Typical High $19.05 | Professional | None | $19.05 | $19.05 | $19.05 |
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 $7.94 Median $7.94 Typical High $8.71 | Professional | 52 · Reduced service | $7.94 | $7.94 | $8.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.16 Median $3.16 Typical High $3.47 | Professional | 53 · Discontinued | $3.16 | $3.16 | $3.47 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $12.02 Median $12.02 Typical High $12.88 | Professional | 54 · Surgery only | $12.02 | $12.02 | $12.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.40 Median $2.40 Typical High $2.57 | Professional | 55 · Aftercare only | $2.40 | $2.40 | $2.57 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.58 Median $1.58 Typical High $1.74 | Professional | 56 · Pre-op care only | $1.58 | $1.58 | $1.74 |
Where South Dakota sits
The same service costs 2.9 times more in Rhode Island 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
$19.50
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.