How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $229.09 Median $257.04 Typical High $338.84 | Facility | None | $229.09 | $257.04 | $338.84 |
Aetna Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $257.04 | Professional | None | $229.09 | $229.09 | $257.04 |
Cigna Setting Professional Modifier None Typical Low $229.09 Median $269.15 Typical High $288.40 | Professional | None | $229.09 | $269.15 | $288.40 |
Hally Health Setting Professional Modifier None Typical Low $218.78 Median $398.11 Typical High $758.58 | Professional | None | $218.78 | $398.11 | $758.58 |
Medica Setting Facility Modifier None Typical Low $245.47 Median $263.03 Typical High $363.08 | Facility | None | $245.47 | $263.03 | $363.08 |
Medica Setting Professional Modifier None Typical Low $218.78 Median $257.04 Typical High $954.99 | Professional | None | $218.78 | $257.04 | $954.99 |
Midlands Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $323.59 | Professional | None | $269.15 | $269.15 | $323.59 |
Midlands Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $354.81 | Professional | None | $269.15 | $269.15 | $354.81 |
Oscar Health Setting Professional Modifier None Typical Low $239.88 Median $398.11 Typical High $478.63 | Professional | None | $239.88 | $398.11 | $478.63 |
United Setting Professional Modifier None Typical Low $223.87 Median $234.42 Typical High $263.03 | Professional | None | $223.87 | $234.42 | $263.03 |
Wellmark Setting Facility Modifier None Typical Low $245.47 Median $245.47 Typical High $245.47 | Facility | None | $245.47 | $245.47 | $245.47 |
Wellmark Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $245.47 | Professional | None | $245.47 | $245.47 | $245.47 |
8 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 Facility Modifier 52 · Reduced service Typical Low $114.82 Median $128.82 Typical High $169.82 | Facility | 52 · Reduced service | $114.82 | $128.82 | $169.82 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $45.71 Median $51.29 Typical High $67.61 | Facility | 53 · Discontinued | $45.71 | $51.29 | $67.61 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $33.88 Median $38.90 Typical High $50.12 | Facility | 55 · Aftercare only | $33.88 | $38.90 | $50.12 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $22.91 Median $25.70 Typical High $33.88 | Facility | 56 · Pre-op care only | $22.91 | $25.70 | $33.88 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $114.82 Median $114.82 Typical High $128.82 | Professional | 52 · Reduced service | $114.82 | $114.82 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $45.71 Typical High $51.29 | Professional | 53 · Discontinued | $45.71 | $45.71 | $51.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $33.88 Typical High $38.90 | Professional | 55 · Aftercare only | $33.88 | $33.88 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.91 Median $22.91 Typical High $25.70 | Professional | 56 · Pre-op care only | $22.91 | $22.91 | $25.70 |
Where Iowa sits
Rates are fairly even across states for this service. 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.
Iowa· 7th of 51
$251
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.