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 $117.49 Median $117.49 Typical High $117.49 | Facility | None | $117.49 | $117.49 | $117.49 |
Aetna Setting Professional Modifier None Typical Low $114.82 Median $138.04 Typical High $138.04 | Professional | None | $114.82 | $138.04 | $138.04 |
Cigna Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $208.93 | Professional | None | $165.96 | $165.96 | $208.93 |
Medica Setting Facility Modifier None Typical Low $165.96 Median $234.42 Typical High $457.09 | Facility | None | $165.96 | $234.42 | $457.09 |
Medica Setting Professional Modifier None Typical Low $50.12 Median $57.54 Typical High $870.96 | Professional | None | $50.12 | $57.54 | $870.96 |
Sanford Health Plan Setting Professional Modifier None Typical Low $141.25 Median $141.25 Typical High $173.78 | Professional | None | $141.25 | $141.25 | $173.78 |
United Setting Professional Modifier None Typical Low $47.86 Median $50.12 Typical High $74.13 | Professional | None | $47.86 | $50.12 | $74.13 |
Wellmark Setting Professional Modifier None Typical Low $117.49 Median $117.49 Typical High $117.49 | Professional | None | $117.49 | $117.49 | $117.49 |
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 $57.54 Median $69.18 Typical High $69.18 | Professional | 52 · Reduced service | $57.54 | $69.18 | $69.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $28.18 Typical High $28.18 | Professional | 53 · Discontinued | $22.91 | $28.18 | $28.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $20.89 Typical High $20.89 | Professional | 55 · Aftercare only | $17.38 | $20.89 | $20.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $13.80 Typical High $13.80 | Professional | 56 · Pre-op care only | $11.48 | $13.80 | $13.80 |
Where South Dakota sits
The same service costs 3.4 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· 13th of 51
$117
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.