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 $20.89 Median $20.89 Typical High $20.89 | Facility | None | $20.89 | $20.89 | $20.89 |
Aetna Setting Professional Modifier None Typical Low $21.38 Median $24.55 Typical High $24.55 | Professional | None | $21.38 | $24.55 | $24.55 |
Cigna Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $45.71 | Professional | None | $36.31 | $36.31 | $45.71 |
Medica Setting Facility Modifier None Typical Low $33.88 Median $41.69 Typical High $41.69 | Facility | None | $33.88 | $41.69 | $41.69 |
Medica Setting Professional Modifier None Typical Low $10.00 Median $10.47 Typical High $165.96 | Professional | None | $10.00 | $10.47 | $165.96 |
Sanford Health Plan Setting Professional Modifier None Typical Low $25.12 Median $25.12 Typical High $30.90 | Professional | None | $25.12 | $25.12 | $30.90 |
United Setting Professional Modifier None Typical Low $9.77 Median $10.00 Typical High $15.49 | Professional | None | $9.77 | $10.00 | $15.49 |
Wellmark Setting Professional Modifier None Typical Low $20.42 Median $20.42 Typical High $20.42 | Professional | None | $20.42 | $20.42 | $20.42 |
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 $10.72 Median $12.30 Typical High $12.30 | Professional | 52 · Reduced service | $10.72 | $12.30 | $12.30 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.27 Median $4.90 Typical High $4.90 | Professional | 53 · Discontinued | $4.27 | $4.90 | $4.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.24 Median $3.72 Typical High $3.72 | Professional | 55 · Aftercare only | $3.24 | $3.72 | $3.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.14 Median $2.45 Typical High $2.45 | Professional | 56 · Pre-op care only | $2.14 | $2.45 | $2.45 |
Where South Dakota sits
The same service costs 3.5 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· 21st of 51
$20.89
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.