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 $69.18 Median $69.18 Typical High $69.18 | Facility | None | $69.18 | $69.18 | $69.18 |
Aetna Setting Professional Modifier None Typical Low $70.79 Median $81.28 Typical High $81.28 | Professional | None | $70.79 | $81.28 | $81.28 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $97.72 Typical High $123.03 | Professional | None | $97.72 | $97.72 | $123.03 |
Medica Setting Facility Modifier None Typical Low $58.88 Median $138.04 Typical High $138.04 | Facility | None | $58.88 | $138.04 | $138.04 |
Medica Setting Professional Modifier None Typical Low $32.36 Median $33.11 Typical High $436.52 | Professional | None | $32.36 | $33.11 | $436.52 |
Sanford Health Plan Setting Professional Modifier None Typical Low $83.18 Median $83.18 Typical High $102.33 | Professional | None | $83.18 | $83.18 | $102.33 |
United Setting Professional Modifier None Typical Low $12.88 Median $32.36 Typical High $47.86 | Professional | None | $12.88 | $32.36 | $47.86 |
Wellmark Setting Professional Modifier None Typical Low $70.79 Median $70.79 Typical High $70.79 | Professional | None | $70.79 | $70.79 | $70.79 |
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 $34.67 Median $40.74 Typical High $40.74 | Professional | 52 · Reduced service | $34.67 | $40.74 | $40.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.13 Median $16.22 Typical High $16.22 | Professional | 53 · Discontinued | $14.13 | $16.22 | $16.22 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.47 Median $12.30 Typical High $12.30 | Professional | 55 · Aftercare only | $10.47 | $12.30 | $12.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.08 Median $8.13 Typical High $8.13 | Professional | 56 · Pre-op care only | $7.08 | $8.13 | $8.13 |
Where South Dakota sits
The same service costs 2.6 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· 12th of 51
$70.79
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.