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 $24.55 Median $24.55 Typical High $40.74 | Facility | None | $24.55 | $24.55 | $40.74 |
Aetna Setting Professional Modifier None Typical Low $22.91 Median $33.11 Typical High $39.81 | Professional | None | $22.91 | $33.11 | $39.81 |
Cigna Setting Professional Modifier None Typical Low $19.50 Median $39.81 Typical High $66.07 | Professional | None | $19.50 | $39.81 | $66.07 |
Medica Setting Facility Modifier None Typical Low $32.36 Median $57.54 Typical High $81.28 | Facility | None | $32.36 | $57.54 | $81.28 |
Medica Setting Professional Modifier None Typical Low $33.88 Median $44.67 Typical High $245.47 | Professional | None | $33.88 | $44.67 | $245.47 |
Midlands Setting Professional Modifier None Typical Low $46.77 Median $77.62 Typical High $79.43 | Professional | None | $46.77 | $77.62 | $79.43 |
Sanford Health Plan Setting Professional Modifier None Typical Low $42.66 Median $66.07 Typical High $123.03 | Professional | None | $42.66 | $66.07 | $123.03 |
United Setting Professional Modifier None Typical Low $20.89 Median $34.67 Typical High $52.48 | Professional | None | $20.89 | $34.67 | $52.48 |
Wellmark Setting Professional Modifier None Typical Low $36.31 Median $42.66 Typical High $75.86 | Professional | None | $36.31 | $42.66 | $75.86 |
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 $11.22 Median $16.60 Typical High $19.95 | Professional | 52 · Reduced service | $11.22 | $16.60 | $19.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.57 Median $6.61 Typical High $7.94 | Professional | 53 · Discontinued | $4.57 | $6.61 | $7.94 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.39 Median $5.01 Typical High $6.03 | Professional | 55 · Aftercare only | $3.39 | $5.01 | $6.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.29 Median $3.31 Typical High $3.98 | Professional | 56 · Pre-op care only | $2.29 | $3.31 | $3.98 |
Where South Dakota sits
The same service costs 2.7 times more in Alaska than in New Jersey. 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
$42.66
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.