How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $40.74 Median $426.58 Typical High $977.24 | Facility | None | $40.74 | $426.58 | $977.24 |
Aetna Setting Professional Modifier None Typical Low $30.90 Median $44.67 Typical High $66.07 | Professional | None | $30.90 | $44.67 | $66.07 |
Cigna Setting Facility Modifier None Typical Low $37.15 Median $45.71 Typical High $95.50 | Facility | None | $37.15 | $45.71 | $95.50 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $104.71 Typical High $134.90 | Professional | None | $75.86 | $104.71 | $134.90 |
Medica Setting Facility Modifier None Typical Low $52.48 Median $75.86 Typical High $537.03 | Facility | None | $52.48 | $75.86 | $537.03 |
Medica Setting Professional Modifier None Typical Low $51.29 Median $138.04 Typical High $616.60 | Professional | None | $51.29 | $138.04 | $616.60 |
Midlands Setting Professional Modifier None Typical Low $89.13 Median $89.13 Typical High $125.89 | Professional | None | $89.13 | $89.13 | $125.89 |
Midlands Setting Facility Modifier None Typical Low $37.15 Median $41.69 Typical High $50.12 | Facility | None | $37.15 | $41.69 | $50.12 |
Midlands Setting Professional Modifier None Typical Low $77.62 Median $85.11 Typical High $123.03 | Professional | None | $77.62 | $85.11 | $123.03 |
Sanford Health Plan Setting Professional Modifier None Typical Low $52.48 Median $70.79 Typical High $95.50 | Professional | None | $52.48 | $70.79 | $95.50 |
United Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $223.87 | Facility | None | $125.89 | $125.89 | $223.87 |
United Setting Professional Modifier None Typical Low $44.67 Median $102.33 Typical High $154.88 | Professional | None | $44.67 | $102.33 | $154.88 |
Wellmark Setting Professional Modifier None Typical Low $77.62 Median $91.20 Typical High $131.83 | Professional | None | $77.62 | $91.20 | $131.83 |
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 $15.49 Median $22.39 Typical High $26.30 | Professional | 52 · Reduced service | $15.49 | $22.39 | $26.30 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.17 Median $8.91 Typical High $10.47 | Professional | 53 · Discontinued | $6.17 | $8.91 | $10.47 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $22.91 Median $33.88 Typical High $39.81 | Professional | 54 · Surgery only | $22.91 | $33.88 | $39.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.57 Median $6.76 Typical High $7.94 | Professional | 55 · Aftercare only | $4.57 | $6.76 | $7.94 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.09 Median $4.47 Typical High $5.25 | Professional | 56 · Pre-op care only | $3.09 | $4.47 | $5.25 |
Where South Dakota sits
The same service costs 4.2 times more in Alaska 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· 5th of 51
$89.13
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.