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 $97.72 Median $97.72 Typical High $97.72 | Facility | None | $97.72 | $97.72 | $97.72 |
Aetna Setting Professional Modifier None Typical Low $83.18 Median $114.82 Typical High $114.82 | Professional | None | $83.18 | $114.82 | $114.82 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $117.49 Typical High $147.91 | Professional | None | $117.49 | $117.49 | $147.91 |
Medica Setting Facility Modifier None Typical Low $70.79 Median $194.98 Typical High $194.98 | Facility | None | $70.79 | $194.98 | $194.98 |
Medica Setting Professional Modifier None Typical Low $41.69 Median $46.77 Typical High $616.60 | Professional | None | $41.69 | $46.77 | $616.60 |
Sanford Health Plan Setting Professional Modifier None Typical Low $117.49 Median $117.49 Typical High $141.25 | Professional | None | $117.49 | $117.49 | $141.25 |
United Setting Professional Modifier None Typical Low $12.88 Median $41.69 Typical High $58.88 | Professional | None | $12.88 | $41.69 | $58.88 |
Wellmark Setting Professional Modifier None Typical Low $85.11 Median $85.11 Typical High $85.11 | Professional | None | $85.11 | $85.11 | $85.11 |
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 $41.69 Median $57.54 Typical High $57.54 | Professional | 52 · Reduced service | $41.69 | $57.54 | $57.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $22.91 Typical High $22.91 | Professional | 53 · Discontinued | $16.60 | $22.91 | $22.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $16.98 Typical High $16.98 | Professional | 55 · Aftercare only | $12.59 | $16.98 | $16.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $11.48 Typical High $11.48 | Professional | 56 · Pre-op care only | $8.32 | $11.48 | $11.48 |
Where South Dakota sits
The same service costs 2.6 times more in Hawaii 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· 15th of 51
$85.11
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.