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 $17.38 Median $17.38 Typical High $17.38 | Facility | None | $17.38 | $17.38 | $17.38 |
Aetna Setting Professional Modifier None Typical Low $16.22 Median $20.42 Typical High $20.42 | Professional | None | $16.22 | $20.42 | $20.42 |
Cigna Setting Professional Modifier None Typical Low $23.44 Median $23.44 Typical High $28.84 | Professional | None | $23.44 | $23.44 | $28.84 |
Medica Setting Facility Modifier None Typical Low $26.92 Median $34.67 Typical High $34.67 | Facility | None | $26.92 | $34.67 | $34.67 |
Medica Setting Professional Modifier None Typical Low $8.32 Median $8.32 Typical High $131.83 | Professional | None | $8.32 | $8.32 | $131.83 |
Sanford Health Plan Setting Professional Modifier None Typical Low $20.89 Median $20.89 Typical High $25.70 | Professional | None | $20.89 | $20.89 | $25.70 |
United Setting Professional Modifier None Typical Low $6.03 Median $8.32 Typical High $15.85 | Professional | None | $6.03 | $8.32 | $15.85 |
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 $10.23 Typical High $10.23 | Professional | 52 · Reduced service | $8.13 | $10.23 | $10.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.24 Median $4.07 Typical High $4.07 | Professional | 53 · Discontinued | $3.24 | $4.07 | $4.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.40 Median $3.09 Typical High $3.09 | Professional | 55 · Aftercare only | $2.40 | $3.09 | $3.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.62 Median $2.04 Typical High $2.04 | Professional | 56 · Pre-op care only | $1.62 | $2.04 | $2.04 |
Where South Dakota sits
The same service costs 3.2 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· 22nd of 51
$16.22
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.