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 $46.77 Median $199.53 Typical High $4,365.16 | Facility | None | $46.77 | $199.53 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $37.15 Median $46.77 Typical High $199.53 | Professional | None | $37.15 | $46.77 | $199.53 |
Cigna Setting Professional Modifier None Typical Low $102.33 Median $162.18 Typical High $602.56 | Professional | None | $102.33 | $162.18 | $602.56 |
Medica Setting Facility Modifier None Typical Low $60.26 Median $263.03 Typical High $380.19 | Facility | None | $60.26 | $263.03 | $380.19 |
Medica Setting Professional Modifier None Typical Low $147.91 Median $407.38 Typical High $1,905.46 | Professional | None | $147.91 | $407.38 | $1,905.46 |
Midlands Setting Professional Modifier None Typical Low $109.65 Median $112.20 Typical High $407.38 | Professional | None | $109.65 | $112.20 | $407.38 |
Midlands Setting Professional Modifier None Typical Low $89.13 Median $89.13 Typical High $416.87 | Professional | None | $89.13 | $89.13 | $416.87 |
Sanford Health Plan Setting Professional Modifier None Typical Low $63.10 Median $181.97 Typical High $380.19 | Professional | None | $63.10 | $181.97 | $380.19 |
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 $60.26 Median $128.82 Typical High $562.34 | Professional | None | $60.26 | $128.82 | $562.34 |
Wellmark Setting Professional Modifier None Typical Low $81.28 Median $100.00 Typical High $562.34 | Professional | None | $81.28 | $100.00 | $562.34 |
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 $18.62 Median $23.44 Typical High $100.00 | Professional | 52 · Reduced service | $18.62 | $23.44 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $9.33 Typical High $39.81 | Professional | 53 · Discontinued | $7.41 | $9.33 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $28.18 Median $34.67 Typical High $151.36 | Professional | 54 · Surgery only | $28.18 | $34.67 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $7.08 Typical High $30.20 | Professional | 55 · Aftercare only | $5.62 | $7.08 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.72 Median $4.68 Typical High $19.95 | Professional | 56 · Pre-op care only | $3.72 | $4.68 | $19.95 |
Where South Dakota sits
The same service costs 5.8 times more in Washington than in Virginia. 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· 16th of 51
$200
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.