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 $151.36 Median $151.36 Typical High $151.36 | Facility | None | $151.36 | $151.36 | $151.36 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $177.83 Typical High $177.83 | Professional | None | $144.54 | $177.83 | $177.83 |
Cigna Setting Professional Modifier None Typical Low $181.97 Median $181.97 Typical High $229.09 | Professional | None | $181.97 | $181.97 | $229.09 |
Medica Setting Facility Modifier None Typical Low $251.19 Median $302.00 Typical High $302.00 | Facility | None | $251.19 | $302.00 | $302.00 |
Medica Setting Professional Modifier None Typical Low $61.66 Median $72.44 Typical High $954.99 | Professional | None | $61.66 | $72.44 | $954.99 |
Sanford Health Plan Setting Professional Modifier None Typical Low $181.97 Median $181.97 Typical High $218.78 | Professional | None | $181.97 | $181.97 | $218.78 |
United Setting Professional Modifier None Typical Low $57.54 Median $61.66 Typical High $97.72 | Professional | None | $57.54 | $61.66 | $97.72 |
Wellmark Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
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 $72.44 Median $89.13 Typical High $89.13 | Professional | 52 · Reduced service | $72.44 | $89.13 | $89.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $35.48 Typical High $35.48 | Professional | 53 · Discontinued | $28.84 | $35.48 | $35.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $26.30 Typical High $26.30 | Professional | 55 · Aftercare only | $21.88 | $26.30 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $17.78 Typical High $17.78 | Professional | 56 · Pre-op care only | $14.45 | $17.78 | $17.78 |
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· 3rd of 51
$162
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.