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 $47.86 Median $302.00 Typical High $4,365.16 | Facility | None | $47.86 | $302.00 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $44.67 Median $257.04 Typical High $380.19 | Professional | None | $44.67 | $257.04 | $380.19 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $128.82 Typical High $724.44 | Professional | None | $104.71 | $128.82 | $724.44 |
Medica Setting Facility Modifier None Typical Low $64.57 Median $338.84 Typical High $707.95 | Facility | None | $64.57 | $338.84 | $707.95 |
Medica Setting Professional Modifier None Typical Low $257.04 Median $691.83 Typical High $2,290.87 | Professional | None | $257.04 | $691.83 | $2,290.87 |
Midlands Setting Professional Modifier None Typical Low $112.20 Median $117.49 Typical High $691.83 | Professional | None | $112.20 | $117.49 | $691.83 |
Midlands Setting Professional Modifier None Typical Low $91.20 Median $100.00 Typical High $602.56 | Professional | None | $91.20 | $100.00 | $602.56 |
Sanford Health Plan Setting Professional Modifier None Typical Low $63.10 Median $346.74 Typical High $524.81 | Professional | None | $63.10 | $346.74 | $524.81 |
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 $63.10 Median $134.90 Typical High $851.14 | Professional | None | $63.10 | $134.90 | $851.14 |
Wellmark Setting Professional Modifier None Typical Low $87.10 Median $107.15 Typical High $630.96 | Professional | None | $87.10 | $107.15 | $630.96 |
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 $22.39 Median $25.12 Typical High $141.25 | Professional | 52 · Reduced service | $22.39 | $25.12 | $141.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.12 Median $10.00 Typical High $56.23 | Professional | 53 · Discontinued | $9.12 | $10.00 | $56.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $33.88 Median $38.02 Typical High $213.80 | Professional | 54 · Surgery only | $33.88 | $38.02 | $213.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.76 Median $7.59 Typical High $42.66 | Professional | 55 · Aftercare only | $6.76 | $7.59 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.47 Median $5.01 Typical High $28.18 | Professional | 56 · Pre-op care only | $4.47 | $5.01 | $28.18 |
Where South Dakota sits
The same service costs 4.9 times more in Iowa than in Nebraska. 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· 6th of 51
$347
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.