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 $4.07 Median $4.07 Typical High $4.07 | Facility | None | $4.07 | $4.07 | $4.07 |
Aetna Setting Professional Modifier None Typical Low $4.37 Median $4.37 Typical High $5.13 | Professional | None | $4.37 | $4.37 | $5.13 |
Cigna Setting Facility Modifier None Typical Low $41.69 Median $41.69 Typical High $51.29 | Facility | None | $41.69 | $41.69 | $51.29 |
Cigna Setting Professional Modifier None Typical Low $29.51 Median $30.90 Typical High $38.90 | Professional | None | $29.51 | $30.90 | $38.90 |
Medica Setting Facility Modifier None Typical Low $5.13 Median $7.76 Typical High $7.76 | Facility | None | $5.13 | $7.76 | $7.76 |
Medica Setting Professional Modifier None Typical Low $11.75 Median $14.13 Typical High $134.90 | Professional | None | $11.75 | $14.13 | $134.90 |
Midlands Setting Professional Modifier None Typical Low $29.51 Median $29.51 Typical High $29.51 | Professional | None | $29.51 | $29.51 | $29.51 |
Sanford Health Plan Setting Professional Modifier None Typical Low $8.91 Median $26.92 Typical High $35.48 | Professional | None | $8.91 | $26.92 | $35.48 |
United Setting Professional Modifier None Typical Low $8.91 Median $11.75 Typical High $23.44 | Professional | None | $8.91 | $11.75 | $23.44 |
Wellmark Setting Professional Modifier None Typical Low $20.89 Median $20.89 Typical High $20.89 | Professional | None | $20.89 | $20.89 | $20.89 |
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 $2.19 Median $2.19 Typical High $2.57 | Professional | 52 · Reduced service | $2.19 | $2.19 | $2.57 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.87 Median $0.87 Typical High $1.02 | Professional | 53 · Discontinued | $0.87 | $0.87 | $1.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.66 Median $0.66 Typical High $0.78 | Professional | 55 · Aftercare only | $0.66 | $0.66 | $0.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.44 Median $0.44 Typical High $0.52 | Professional | 56 · Pre-op care only | $0.44 | $0.44 | $0.52 |
Where South Dakota sits
The same service costs 6.9 times more in Montana than in Indiana. 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· 6th of 51
$23.44
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.