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 $60.26 Median $60.26 Typical High $102.33 | Facility | None | $60.26 | $60.26 | $102.33 |
Aetna Setting Professional Modifier None Typical Low $56.23 Median $83.18 Typical High $100.00 | Professional | None | $56.23 | $83.18 | $100.00 |
Cigna Setting Professional Modifier None Typical Low $48.98 Median $100.00 Typical High $162.18 | Professional | None | $48.98 | $100.00 | $162.18 |
Medica Setting Facility Modifier None Typical Low $81.28 Median $144.54 Typical High $275.42 | Facility | None | $81.28 | $144.54 | $275.42 |
Medica Setting Professional Modifier None Typical Low $81.28 Median $104.71 Typical High $741.31 | Professional | None | $81.28 | $104.71 | $741.31 |
Midlands Setting Professional Modifier None Typical Low $117.49 Median $190.55 Typical High $194.98 | Professional | None | $117.49 | $190.55 | $194.98 |
Sanford Health Plan Setting Professional Modifier None Typical Low $104.71 Median $154.88 Typical High $309.03 | Professional | None | $104.71 | $154.88 | $309.03 |
United Setting Professional Modifier None Typical Low $38.02 Median $75.86 Typical High $125.89 | Professional | None | $38.02 | $75.86 | $125.89 |
Wellmark Setting Professional Modifier None Typical Low $89.13 Median $104.71 Typical High $186.21 | Professional | None | $89.13 | $104.71 | $186.21 |
4 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 $28.18 Median $41.69 Typical High $50.12 | Professional | 52 · Reduced service | $28.18 | $41.69 | $50.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.22 Median $16.60 Typical High $20.42 | Professional | 53 · Discontinued | $11.22 | $16.60 | $20.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $12.30 Typical High $15.14 | Professional | 55 · Aftercare only | $8.51 | $12.30 | $15.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.62 Median $8.32 Typical High $10.00 | Professional | 56 · Pre-op care only | $5.62 | $8.32 | $10.00 |
Where South Dakota sits
The same service costs 3.0 times more in Alaska than in Florida. 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· 7th of 51
$100
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.