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 $43.65 Median $43.65 Typical High $43.65 | Facility | None | $43.65 | $43.65 | $43.65 |
Aetna Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $40.74 | Professional | None | $36.31 | $36.31 | $40.74 |
Cigna Setting Professional Modifier None Typical Low $53.70 Median $67.61 Typical High $67.61 | Professional | None | $53.70 | $67.61 | $67.61 |
Medica Setting Facility Modifier None Typical Low $56.23 Median $61.66 Typical High $61.66 | Facility | None | $56.23 | $61.66 | $61.66 |
Medica Setting Professional Modifier None Typical Low $48.98 Median $85.11 Typical High $288.40 | Professional | None | $48.98 | $85.11 | $288.40 |
Midlands Setting Professional Modifier None Typical Low $67.61 Median $67.61 Typical High $75.86 | Professional | None | $67.61 | $67.61 | $75.86 |
Sanford Health Plan Setting Professional Modifier None Typical Low $53.70 Median $56.23 Typical High $87.10 | Professional | None | $53.70 | $56.23 | $87.10 |
United Setting Professional Modifier None Typical Low $48.98 Median $79.43 Typical High $89.13 | Professional | None | $48.98 | $79.43 | $89.13 |
Wellmark Setting Professional Modifier None Typical Low $60.26 Median $77.62 Typical High $77.62 | Professional | None | $60.26 | $77.62 | $77.62 |
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 $18.20 Median $18.20 Typical High $20.42 | Professional | 52 · Reduced service | $18.20 | $18.20 | $20.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.24 Median $7.24 Typical High $8.13 | Professional | 53 · Discontinued | $7.24 | $7.24 | $8.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.37 Median $5.37 Typical High $6.17 | Professional | 55 · Aftercare only | $5.37 | $5.37 | $6.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.63 Median $3.63 Typical High $4.07 | Professional | 56 · Pre-op care only | $3.63 | $3.63 | $4.07 |
Where South Dakota sits
The same service costs 2.6 times more in North Dakota than in Ohio. 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
$61.66
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.