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 $75.86 Median $186.21 Typical High $4,365.16 | Facility | None | $75.86 | $186.21 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $60.26 Median $93.33 Typical High $190.55 | Professional | None | $60.26 | $93.33 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $154.88 Median $257.04 Typical High $562.34 | Professional | None | $154.88 | $257.04 | $562.34 |
Medica Setting Facility Modifier None Typical Low $97.72 Median $239.88 Typical High $426.58 | Facility | None | $97.72 | $239.88 | $426.58 |
Medica Setting Professional Modifier None Typical Low $177.83 Median $389.05 Typical High $2,511.89 | Professional | None | $177.83 | $389.05 | $2,511.89 |
Midlands Setting Professional Modifier None Typical Low $177.83 Median $186.21 Typical High $389.05 | Professional | None | $177.83 | $186.21 | $389.05 |
Midlands Setting Professional Modifier None Typical Low $144.54 Median $151.36 Typical High $380.19 | Professional | None | $144.54 | $151.36 | $380.19 |
Sanford Health Plan Setting Professional Modifier None Typical Low $87.10 Median $194.98 Typical High $346.74 | Professional | None | $87.10 | $194.98 | $346.74 |
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 $97.72 Median $208.93 Typical High $524.81 | Professional | None | $97.72 | $208.93 | $524.81 |
Wellmark Setting Professional Modifier None Typical Low $128.82 Median $158.49 Typical High $478.63 | Professional | None | $128.82 | $158.49 | $478.63 |
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 $30.20 Median $37.15 Typical High $93.33 | Professional | 52 · Reduced service | $30.20 | $37.15 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $15.14 Typical High $37.15 | Professional | 53 · Discontinued | $12.02 | $15.14 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $45.71 Median $56.23 Typical High $141.25 | Professional | 54 · Surgery only | $45.71 | $56.23 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.12 Median $11.22 Typical High $28.18 | Professional | 55 · Aftercare only | $9.12 | $11.22 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.03 Median $7.59 Typical High $18.62 | Professional | 56 · Pre-op care only | $6.03 | $7.59 | $18.62 |
Where South Dakota sits
The same service costs 3.8 times more in Alaska 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· 12th of 51
$209
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.