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 $346.74 Median $1,995.26 Typical High $4,365.16 | Facility | None | $346.74 | $1,995.26 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $338.84 Median $489.78 Typical High $2,290.87 | Professional | None | $338.84 | $489.78 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $776.25 Median $1,202.26 Typical High $5,623.41 | Professional | None | $776.25 | $1,202.26 | $5,623.41 |
Medica Setting Facility Modifier None Typical Low $489.78 Median $2,041.74 Typical High $5,370.32 | Facility | None | $489.78 | $2,041.74 | $5,370.32 |
Medica Setting Professional Modifier None Typical Low $1,698.24 Median $4,265.80 Typical High $7,585.78 | Professional | None | $1,698.24 | $4,265.80 | $7,585.78 |
Midlands Setting Professional Modifier None Typical Low $794.33 Median $870.96 Typical High $4,265.80 | Professional | None | $794.33 | $870.96 | $4,265.80 |
Midlands Setting Professional Modifier None Typical Low $676.08 Median $724.44 Typical High $3,890.45 | Professional | None | $676.08 | $724.44 | $3,890.45 |
Sanford Health Plan Setting Professional Modifier None Typical Low $524.81 Median $2,344.23 Typical High $3,630.78 | Professional | None | $524.81 | $2,344.23 | $3,630.78 |
United Setting Facility Modifier None Typical Low $5,370.32 Median $5,370.32 Typical High $5,370.32 | Facility | None | $5,370.32 | $5,370.32 | $5,370.32 |
United Setting Professional Modifier None Typical Low $467.74 Median $954.99 Typical High $5,495.41 | Professional | None | $467.74 | $954.99 | $5,495.41 |
Wellmark Setting Professional Modifier None Typical Low $691.83 Median $831.76 Typical High $5,888.44 | Professional | None | $691.83 | $831.76 | $5,888.44 |
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 $169.82 Median $186.21 Typical High $1,023.29 | Professional | 52 · Reduced service | $169.82 | $186.21 | $1,023.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $67.61 Median $75.86 Typical High $407.38 | Professional | 53 · Discontinued | $67.61 | $75.86 | $407.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $257.04 Median $281.84 Typical High $1,548.82 | Professional | 54 · Surgery only | $257.04 | $281.84 | $1,548.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $51.29 Median $56.23 Typical High $309.03 | Professional | 55 · Aftercare only | $51.29 | $56.23 | $309.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $33.88 Median $38.02 Typical High $204.17 | Professional | 56 · Pre-op care only | $33.88 | $38.02 | $204.17 |
Where South Dakota sits
The same service costs 6.2 times more in Washington than in Maryland. 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· 10th of 51
$2,138
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.