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 $87.10 Median $87.10 Typical High $87.10 | Facility | None | $87.10 | $87.10 | $87.10 |
Aetna Setting Professional Modifier None Typical Low $75.86 Median $102.33 Typical High $102.33 | Professional | None | $75.86 | $102.33 | $102.33 |
Cigna Setting Professional Modifier None Typical Low $123.03 Median $123.03 Typical High $154.88 | Professional | None | $123.03 | $123.03 | $154.88 |
Medica Setting Facility Modifier None Typical Low $60.26 Median $173.78 Typical High $173.78 | Facility | None | $60.26 | $173.78 | $173.78 |
Medica Setting Professional Modifier None Typical Low $37.15 Median $42.66 Typical High $588.84 | Professional | None | $37.15 | $42.66 | $588.84 |
Sanford Health Plan Setting Professional Modifier None Typical Low $104.71 Median $104.71 Typical High $128.82 | Professional | None | $104.71 | $104.71 | $128.82 |
United Setting Professional Modifier None Typical Low $10.96 Median $37.15 Typical High $52.48 | Professional | None | $10.96 | $37.15 | $52.48 |
Wellmark Setting Professional Modifier None Typical Low $72.44 Median $72.44 Typical High $72.44 | Professional | None | $72.44 | $72.44 | $72.44 |
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 $38.02 Median $51.29 Typical High $51.29 | Professional | 52 · Reduced service | $38.02 | $51.29 | $51.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.14 Median $20.89 Typical High $20.89 | Professional | 53 · Discontinued | $15.14 | $20.89 | $20.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.22 Median $15.49 Typical High $15.49 | Professional | 55 · Aftercare only | $11.22 | $15.49 | $15.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $10.23 Typical High $10.23 | Professional | 56 · Pre-op care only | $7.59 | $10.23 | $10.23 |
Where South Dakota sits
The same service costs 3.5 times more in Hawaii than in New York. 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· 20th of 51
$72.44
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.