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 $54.95 Median $54.95 Typical High $54.95 | Facility | None | $54.95 | $54.95 | $54.95 |
Aetna Setting Professional Modifier None Typical Low $51.29 Median $64.57 Typical High $64.57 | Professional | None | $51.29 | $64.57 | $64.57 |
Cigna Setting Professional Modifier None Typical Low $72.44 Median $74.13 Typical High $91.20 | Professional | None | $72.44 | $74.13 | $91.20 |
Medica Setting Facility Modifier None Typical Low $43.65 Median $109.65 Typical High $109.65 | Facility | None | $43.65 | $109.65 | $109.65 |
Medica Setting Professional Modifier None Typical Low $25.70 Median $26.30 Typical High $398.11 | Professional | None | $25.70 | $26.30 | $398.11 |
Sanford Health Plan Setting Professional Modifier None Typical Low $66.07 Median $66.07 Typical High $79.43 | Professional | None | $66.07 | $66.07 | $79.43 |
United Setting Professional Modifier None Typical Low $12.88 Median $25.70 Typical High $43.65 | Professional | None | $12.88 | $25.70 | $43.65 |
Wellmark Setting Professional Modifier None Typical Low $52.48 Median $52.48 Typical High $52.48 | Professional | None | $52.48 | $52.48 | $52.48 |
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 $25.70 Median $32.36 Typical High $32.36 | Professional | 52 · Reduced service | $25.70 | $32.36 | $32.36 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $12.88 Typical High $12.88 | Professional | 53 · Discontinued | $10.23 | $12.88 | $12.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $9.55 Typical High $9.55 | Professional | 55 · Aftercare only | $7.76 | $9.55 | $9.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $6.46 Typical High $6.46 | Professional | 56 · Pre-op care only | $5.13 | $6.46 | $6.46 |
Where South Dakota sits
The same service costs 2.8 times more in Montana 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· 18th of 51
$52.48
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.