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 $16.22 Median $16.22 Typical High $16.22 | Facility | None | $16.22 | $16.22 | $16.22 |
Aetna Setting Professional Modifier None Typical Low $16.22 Median $19.05 Typical High $19.05 | Professional | None | $16.22 | $19.05 | $19.05 |
Cigna Setting Professional Modifier None Typical Low $24.55 Median $24.55 Typical High $30.90 | Professional | None | $24.55 | $24.55 | $30.90 |
Medica Setting Facility Modifier None Typical Low $26.30 Median $32.36 Typical High $32.36 | Facility | None | $26.30 | $32.36 | $32.36 |
Medica Setting Professional Modifier None Typical Low $7.76 Median $8.13 Typical High $123.03 | Professional | None | $7.76 | $8.13 | $123.03 |
Sanford Health Plan Setting Professional Modifier None Typical Low $19.50 Median $19.50 Typical High $23.99 | Professional | None | $19.50 | $19.50 | $23.99 |
United Setting Professional Modifier None Typical Low $7.76 Median $8.13 Typical High $19.05 | Professional | None | $7.76 | $8.13 | $19.05 |
Wellmark Setting Professional Modifier None Typical Low $16.22 Median $16.22 Typical High $16.22 | Professional | None | $16.22 | $16.22 | $16.22 |
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 $8.13 Median $9.55 Typical High $9.55 | Professional | 52 · Reduced service | $8.13 | $9.55 | $9.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.24 Median $3.89 Typical High $3.89 | Professional | 53 · Discontinued | $3.24 | $3.89 | $3.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.45 Median $2.88 Typical High $2.88 | Professional | 55 · Aftercare only | $2.45 | $2.88 | $2.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.62 Median $1.91 Typical High $1.91 | Professional | 56 · Pre-op care only | $1.62 | $1.91 | $1.91 |
Where South Dakota sits
The same service costs 3.0 times more in Montana 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· 23rd of 51
$16.60
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.