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 $77.62 Median $77.62 Typical High $77.62 | Facility | None | $77.62 | $77.62 | $77.62 |
Aetna Setting Professional Modifier None Typical Low $58.88 Median $91.20 Typical High $91.20 | Professional | None | $58.88 | $91.20 | $91.20 |
Cigna Setting Professional Modifier None Typical Low $85.11 Median $85.11 Typical High $107.15 | Professional | None | $85.11 | $85.11 | $107.15 |
Medica Setting Facility Modifier None Typical Low $50.12 Median $154.88 Typical High $154.88 | Facility | None | $50.12 | $154.88 | $154.88 |
Medica Setting Professional Modifier None Typical Low $30.20 Median $37.15 Typical High $478.63 | Professional | None | $30.20 | $37.15 | $478.63 |
Sanford Health Plan Setting Professional Modifier None Typical Low $93.33 Median $93.33 Typical High $112.20 | Professional | None | $93.33 | $93.33 | $112.20 |
United Setting Professional Modifier None Typical Low $28.84 Median $30.20 Typical High $46.77 | Professional | None | $28.84 | $30.20 | $46.77 |
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 $29.51 Median $45.71 Typical High $45.71 | Professional | 52 · Reduced service | $29.51 | $45.71 | $45.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.75 Median $18.20 Typical High $18.20 | Professional | 53 · Discontinued | $11.75 | $18.20 | $18.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.91 Median $13.49 Typical High $13.49 | Professional | 55 · Aftercare only | $8.91 | $13.49 | $13.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.89 Median $9.12 Typical High $9.12 | Professional | 56 · Pre-op care only | $5.89 | $9.12 | $9.12 |
Where South Dakota sits
The same service costs 2.8 times more in Montana than in Alabama. 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· 9th 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.