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 $169.82 Typical High $4,365.16 | Facility | None | $77.62 | $169.82 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $63.10 Median $100.00 Typical High $162.18 | Professional | None | $63.10 | $100.00 | $162.18 |
Cigna Setting Professional Modifier None Typical Low $165.96 Median $213.80 Typical High $478.63 | Professional | None | $165.96 | $213.80 | $478.63 |
Medica Setting Facility Modifier None Typical Low $89.13 Median $204.17 Typical High $389.05 | Facility | None | $89.13 | $204.17 | $389.05 |
Medica Setting Professional Modifier None Typical Low $181.97 Median $380.19 Typical High $1,737.80 | Professional | None | $181.97 | $380.19 | $1,737.80 |
Midlands Setting Professional Modifier None Typical Low $181.97 Median $190.55 Typical High $380.19 | Professional | None | $181.97 | $190.55 | $380.19 |
Midlands Setting Professional Modifier None Typical Low $151.36 Median $158.49 Typical High $346.74 | Professional | None | $151.36 | $158.49 | $346.74 |
Sanford Health Plan Setting Professional Modifier None Typical Low $91.20 Median $194.98 Typical High $295.12 | Professional | None | $91.20 | $194.98 | $295.12 |
United Setting Facility Modifier None Typical Low $812.83 Median $812.83 Typical High $812.83 | Facility | None | $812.83 | $812.83 | $812.83 |
United Setting Professional Modifier None Typical Low $102.33 Median $218.78 Typical High $478.63 | Professional | None | $102.33 | $218.78 | $478.63 |
Wellmark Setting Professional Modifier None Typical Low $120.23 Median $147.91 Typical High $363.08 | Professional | None | $120.23 | $147.91 | $363.08 |
5 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 $31.62 Median $38.90 Typical High $81.28 | Professional | 52 · Reduced service | $31.62 | $38.90 | $81.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.59 Median $15.49 Typical High $32.36 | Professional | 53 · Discontinued | $12.59 | $15.49 | $32.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $46.77 Median $58.88 Typical High $123.03 | Professional | 54 · Surgery only | $46.77 | $58.88 | $123.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.33 Median $11.75 Typical High $24.55 | Professional | 55 · Aftercare only | $9.33 | $11.75 | $24.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.31 Median $7.76 Typical High $16.22 | Professional | 56 · Pre-op care only | $6.31 | $7.76 | $16.22 |
Where South Dakota sits
The same service costs 2.6 times more in Wisconsin than in Utah. 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
$214
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.