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 $35.48 Median $35.48 Typical High $4,365.16 | Facility | None | $35.48 | $35.48 | $4,365.16 |
Aetna Setting Professional Modifier None (both parts) Typical Low $50.12 Median $52.48 Typical High $52.48 | Professional | None (both parts) | $50.12 | $52.48 | $52.48 |
Aetna Setting Professional Modifier 26 · Professional part Typical Low $19.95 Median $19.95 Typical High $20.42 | Professional | 26 · Professional part | $19.95 | $19.95 | $20.42 |
Aetna Setting Professional Modifier TC · Technical part Typical Low $30.20 Median $32.36 Typical High $32.36 | Professional | TC · Technical part | $30.20 | $32.36 | $32.36 |
Medica Setting Facility Modifier None Typical Low $74.13 Median $89.13 Typical High $89.13 | Facility | None | $74.13 | $89.13 | $89.13 |
Medica Setting Professional Modifier None (both parts) Typical Low $51.29 Median $109.65 Typical High $398.11 | Professional | None (both parts) | $51.29 | $109.65 | $398.11 |
Medica Setting Professional Modifier 26 · Professional part Typical Low $21.88 Median $42.66 Typical High $158.49 | Professional | 26 · Professional part | $21.88 | $42.66 | $158.49 |
Medica Setting Professional Modifier TC · Technical part Typical Low $35.48 Median $69.18 Typical High $239.88 | Professional | TC · Technical part | $35.48 | $69.18 | $239.88 |
Midlands Setting Professional Modifier None Typical Low $67.61 Median $67.61 Typical High $67.61 | Professional | None | $67.61 | $67.61 | $67.61 |
United Setting Professional Modifier None (both parts) Typical Low $51.29 Median $93.33 Typical High $109.65 | Professional | None (both parts) | $51.29 | $93.33 | $109.65 |
United Setting Professional Modifier 26 · Professional part Typical Low $19.50 Median $36.31 Typical High $42.66 | Professional | 26 · Professional part | $19.50 | $36.31 | $42.66 |
United Setting Professional Modifier TC · Technical part Typical Low $31.62 Median $58.88 Typical High $69.18 | Professional | TC · Technical part | $31.62 | $58.88 | $69.18 |
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 $25.12 Median $26.30 Typical High $26.30 | Professional | 52 · Reduced service | $25.12 | $26.30 | $26.30 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.00 Median $10.47 Typical High $10.47 | Professional | 53 · Discontinued | $10.00 | $10.47 | $10.47 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $38.90 Typical High $38.90 | Professional | 54 · Surgery only | $38.02 | $38.90 | $38.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $7.76 Typical High $7.76 | Professional | 55 · Aftercare only | $7.59 | $7.76 | $7.76 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.01 Median $5.25 Typical High $5.25 | Professional | 56 · Pre-op care only | $5.01 | $5.25 | $5.25 |
Where South Dakota sits
The same service costs 3.3 times more in Nebraska 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· 5th of 51
$93.33
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.