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 $85.11 Median $85.11 Typical High $85.11 | Facility | None | $85.11 | $85.11 | $85.11 |
Aetna Setting Professional Modifier None Typical Low $83.18 Median $100.00 Typical High $100.00 | Professional | None | $83.18 | $100.00 | $100.00 |
Cigna Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $158.49 | Professional | None | $128.82 | $128.82 | $158.49 |
Medica Setting Facility Modifier None Typical Low $134.90 Median $169.82 Typical High $169.82 | Facility | None | $134.90 | $169.82 | $169.82 |
Medica Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $645.65 | Professional | None | $40.74 | $40.74 | $645.65 |
Sanford Health Plan Setting Professional Modifier None Typical Low $102.33 Median $102.33 Typical High $125.89 | Professional | None | $102.33 | $102.33 | $125.89 |
United Setting Professional Modifier None Typical Low $38.02 Median $40.74 Typical High $60.26 | Professional | None | $38.02 | $40.74 | $60.26 |
Wellmark Setting Professional Modifier None Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | None | $83.18 | $83.18 | $83.18 |
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 $50.12 Typical High $50.12 | Professional | 52 · Reduced service | $41.69 | $50.12 | $50.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $19.95 Typical High $19.95 | Professional | 53 · Discontinued | $16.98 | $19.95 | $19.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $15.14 Typical High $15.14 | Professional | 55 · Aftercare only | $12.59 | $15.14 | $15.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $10.00 Typical High $10.00 | Professional | 56 · Pre-op care only | $8.32 | $10.00 | $10.00 |
Where South Dakota sits
The same service costs 2.6 times more in Hawaii than in Indiana. 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· 17th 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.