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 $93.33 Median $93.33 Typical High $93.33 | Facility | None | $93.33 | $93.33 | $93.33 |
Aetna Setting Professional Modifier None Typical Low $77.62 Median $109.65 Typical High $109.65 | Professional | None | $77.62 | $109.65 | $109.65 |
Cigna Setting Professional Modifier None Typical Low $112.20 Median $112.20 Typical High $138.04 | Professional | None | $112.20 | $112.20 | $138.04 |
Medica Setting Facility Modifier None Typical Low $128.82 Median $181.97 Typical High $181.97 | Facility | None | $128.82 | $181.97 | $181.97 |
Medica Setting Professional Modifier None Typical Low $39.81 Median $44.67 Typical High $630.96 | Professional | None | $39.81 | $44.67 | $630.96 |
Sanford Health Plan Setting Professional Modifier None Typical Low $112.20 Median $112.20 Typical High $134.90 | Professional | None | $112.20 | $112.20 | $134.90 |
United Setting Professional Modifier None Typical Low $15.14 Median $39.81 Typical High $64.57 | Professional | None | $15.14 | $39.81 | $64.57 |
Wellmark Setting Professional Modifier None Typical Low $77.62 Median $77.62 Typical High $77.62 | Professional | None | $77.62 | $77.62 | $77.62 |
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 $38.90 Median $54.95 Typical High $54.95 | Professional | 52 · Reduced service | $38.90 | $54.95 | $54.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.49 Median $21.88 Typical High $21.88 | Professional | 53 · Discontinued | $15.49 | $21.88 | $21.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.75 Median $16.22 Typical High $16.22 | Professional | 55 · Aftercare only | $11.75 | $16.22 | $16.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $10.96 Typical High $10.96 | Professional | 56 · Pre-op care only | $7.76 | $10.96 | $10.96 |
Where South Dakota sits
The same service costs 2.5 times more in Montana than in Missouri. 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· 21st of 51
$77.62
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.