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 $5.25 Median $5.25 Typical High $5.25 | Facility | None | $5.25 | $5.25 | $5.25 |
Aetna Setting Professional Modifier None Typical Low $4.90 Median $4.90 Typical High $5.37 | Professional | None | $4.90 | $4.90 | $5.37 |
Cigna Setting Facility Modifier None Typical Low $10.96 Median $10.96 Typical High $13.80 | Facility | None | $10.96 | $10.96 | $13.80 |
Cigna Setting Professional Modifier None Typical Low $7.94 Median $8.32 Typical High $10.23 | Professional | None | $7.94 | $8.32 | $10.23 |
Medica Setting Facility Modifier None Typical Low $7.41 Median $8.32 Typical High $9.55 | Facility | None | $7.41 | $8.32 | $9.55 |
Medica Setting Professional Modifier None Typical Low $2.88 Median $3.63 Typical High $63.10 | Professional | None | $2.88 | $3.63 | $63.10 |
Midlands Setting Professional Modifier None Typical Low $7.94 Median $7.94 Typical High $7.94 | Professional | None | $7.94 | $7.94 | $7.94 |
Midlands Setting Professional Modifier None Typical Low $6.61 Median $6.61 Typical High $12.88 | Professional | None | $6.61 | $6.61 | $12.88 |
Sanford Health Plan Setting Professional Modifier None Typical Low $6.17 Median $7.24 Typical High $9.12 | Professional | None | $6.17 | $7.24 | $9.12 |
United Setting Professional Modifier None Typical Low $2.40 Median $2.88 Typical High $6.03 | Professional | None | $2.40 | $2.88 | $6.03 |
Wellmark Setting Professional Modifier None Typical Low $5.89 Median $5.89 Typical High $5.89 | Professional | None | $5.89 | $5.89 | $5.89 |
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 $2.45 Median $2.45 Typical High $2.69 | Professional | 52 · Reduced service | $2.45 | $2.45 | $2.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.00 Median $1.00 Typical High $1.07 | Professional | 53 · Discontinued | $1.00 | $1.00 | $1.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.72 Median $3.72 Typical High $3.98 | Professional | 54 · Surgery only | $3.72 | $3.72 | $3.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.74 Median $0.74 Typical High $0.79 | Professional | 55 · Aftercare only | $0.74 | $0.74 | $0.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.49 Median $0.49 Typical High $0.52 | Professional | 56 · Pre-op care only | $0.49 | $0.49 | $0.52 |
Where South Dakota sits
The same service costs 2.7 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
$6.17
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.