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 $134.90 Median $602.56 Typical High $4,365.16 | Facility | None | $134.90 | $602.56 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $128.82 Median $181.97 Typical High $691.83 | Professional | None | $128.82 | $181.97 | $691.83 |
Cigna Setting Professional Modifier None Typical Low $295.12 Median $478.63 Typical High $1,659.59 | Professional | None | $295.12 | $478.63 | $1,659.59 |
Medica Setting Facility Modifier None Typical Low $186.21 Median $776.25 Typical High $1,000.00 | Facility | None | $186.21 | $776.25 | $1,000.00 |
Medica Setting Professional Modifier None Typical Low $512.86 Median $1,288.25 Typical High $4,265.80 | Professional | None | $512.86 | $1,288.25 | $4,265.80 |
Midlands Setting Professional Modifier None Typical Low $316.23 Median $338.84 Typical High $1,288.25 | Professional | None | $316.23 | $338.84 | $1,288.25 |
Midlands Setting Professional Modifier None Typical Low $257.04 Median $295.12 Typical High $1,230.27 | Professional | None | $257.04 | $295.12 | $1,230.27 |
Sanford Health Plan Setting Professional Modifier None Typical Low $199.53 Median $707.95 Typical High $1,047.13 | Professional | None | $199.53 | $707.95 | $1,047.13 |
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 $186.21 Median $380.19 Typical High $1,659.59 | Professional | None | $186.21 | $380.19 | $1,659.59 |
Wellmark Setting Professional Modifier None Typical Low $257.04 Median $316.23 Typical High $1,445.44 | Professional | None | $257.04 | $316.23 | $1,445.44 |
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 $64.57 Median $70.79 Typical High $302.00 | Professional | 52 · Reduced service | $64.57 | $70.79 | $302.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $28.84 Typical High $120.23 | Professional | 53 · Discontinued | $25.70 | $28.84 | $120.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $107.15 Typical High $446.68 | Professional | 54 · Surgery only | $97.72 | $107.15 | $446.68 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $21.38 Typical High $89.13 | Professional | 55 · Aftercare only | $19.50 | $21.38 | $89.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $14.13 Typical High $60.26 | Professional | 56 · Pre-op care only | $12.88 | $14.13 | $60.26 |
Where South Dakota sits
The same service costs 3.8 times more in Wisconsin 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· 7th of 51
$692
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.