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 $107.15 Median $107.15 Typical High $107.15 | Facility | None | $107.15 | $107.15 | $107.15 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $125.89 Typical High $125.89 | Professional | None | $104.71 | $125.89 | $125.89 |
Cigna Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $186.21 | Professional | None | $151.36 | $151.36 | $186.21 |
Medica Setting Facility Modifier None Typical Low $173.78 Median $213.80 Typical High $213.80 | Facility | None | $173.78 | $213.80 | $213.80 |
Medica Setting Professional Modifier None Typical Low $51.29 Median $53.70 Typical High $707.95 | Professional | None | $51.29 | $53.70 | $707.95 |
Sanford Health Plan Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $158.49 | Professional | None | $128.82 | $128.82 | $158.49 |
United Setting Professional Modifier None Typical Low $15.14 Median $51.29 Typical High $70.79 | Professional | None | $15.14 | $51.29 | $70.79 |
Wellmark Setting Professional Modifier None Typical Low $104.71 Median $104.71 Typical High $104.71 | Professional | None | $104.71 | $104.71 | $104.71 |
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 $52.48 Median $63.10 Typical High $63.10 | Professional | 52 · Reduced service | $52.48 | $63.10 | $63.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $25.12 Typical High $25.12 | Professional | 53 · Discontinued | $20.89 | $25.12 | $25.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $19.05 Typical High $19.05 | Professional | 55 · Aftercare only | $15.85 | $19.05 | $19.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $12.59 Typical High $12.59 | Professional | 56 · Pre-op care only | $10.47 | $12.59 | $12.59 |
Where South Dakota sits
The same service costs 2.9 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
$105
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.