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 $83.18 Median $295.12 Typical High $4,365.16 | Facility | None | $83.18 | $295.12 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $67.61 Median $107.15 Typical High $309.03 | Professional | None | $67.61 | $107.15 | $309.03 |
Cigna Setting Professional Modifier None Typical Low $165.96 Median $229.09 Typical High $870.96 | Professional | None | $165.96 | $229.09 | $870.96 |
Medica Setting Facility Modifier None Typical Low $107.15 Median $380.19 Typical High $616.60 | Facility | None | $107.15 | $380.19 | $616.60 |
Medica Setting Professional Modifier None Typical Low $245.47 Median $602.56 Typical High $2,691.53 | Professional | None | $245.47 | $602.56 | $2,691.53 |
Midlands Setting Professional Modifier None Typical Low $194.98 Median $204.17 Typical High $602.56 | Professional | None | $194.98 | $204.17 | $602.56 |
Midlands Setting Professional Modifier None Typical Low $162.18 Median $165.96 Typical High $602.56 | Professional | None | $162.18 | $165.96 | $602.56 |
Sanford Health Plan Setting Professional Modifier None Typical Low $109.65 Median $295.12 Typical High $549.54 | Professional | None | $109.65 | $295.12 | $549.54 |
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 $109.65 Median $234.42 Typical High $831.76 | Professional | None | $109.65 | $234.42 | $831.76 |
Wellmark Setting Professional Modifier None Typical Low $144.54 Median $177.83 Typical High $831.76 | Professional | None | $144.54 | $177.83 | $831.76 |
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 $33.88 Median $41.69 Typical High $147.91 | Professional | 52 · Reduced service | $33.88 | $41.69 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.49 Median $16.60 Typical High $58.88 | Professional | 53 · Discontinued | $13.49 | $16.60 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $50.12 Median $63.10 Typical High $223.87 | Professional | 54 · Surgery only | $50.12 | $63.10 | $223.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $12.59 Typical High $44.67 | Professional | 55 · Aftercare only | $10.00 | $12.59 | $44.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.76 Median $8.32 Typical High $29.51 | Professional | 56 · Pre-op care only | $6.76 | $8.32 | $29.51 |
Where South Dakota sits
The same service costs 4.2 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· 12th of 51
$295
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.