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 $234.42 Median $1,348.96 Typical High $4,365.16 | Facility | None | $234.42 | $1,348.96 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $223.87 Median $1,096.48 Typical High $1,479.11 | Professional | None | $223.87 | $1,096.48 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $524.81 Median $660.69 Typical High $3,801.89 | Professional | None | $524.81 | $660.69 | $3,801.89 |
Medica Setting Facility Modifier None Typical Low $331.13 Median $1,380.38 Typical High $2,238.72 | Facility | None | $331.13 | $1,380.38 | $2,238.72 |
Medica Setting Professional Modifier None Typical Low $1,148.15 Median $2,951.21 Typical High $4,897.79 | Professional | None | $1,148.15 | $2,951.21 | $4,897.79 |
Midlands Setting Professional Modifier None Typical Low $537.03 Median $588.84 Typical High $2,951.21 | Professional | None | $537.03 | $588.84 | $2,951.21 |
Midlands Setting Professional Modifier None Typical Low $457.09 Median $467.74 Typical High $2,570.40 | Professional | None | $457.09 | $467.74 | $2,570.40 |
Sanford Health Plan Setting Professional Modifier None Typical Low $363.08 Median $1,584.89 Typical High $2,398.83 | Professional | None | $363.08 | $1,584.89 | $2,398.83 |
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 $316.23 Median $645.65 Typical High $3,715.35 | Professional | None | $316.23 | $645.65 | $3,715.35 |
Wellmark Setting Professional Modifier None Typical Low $467.74 Median $575.44 Typical High $3,890.45 | Professional | None | $467.74 | $575.44 | $3,890.45 |
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 $114.82 Median $125.89 Typical High $676.08 | Professional | 52 · Reduced service | $114.82 | $125.89 | $676.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $51.29 Typical High $269.15 | Professional | 53 · Discontinued | $45.71 | $51.29 | $269.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $169.82 Median $190.55 Typical High $1,000.00 | Professional | 54 · Surgery only | $169.82 | $190.55 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $34.67 Median $38.02 Typical High $199.53 | Professional | 55 · Aftercare only | $34.67 | $38.02 | $199.53 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.91 Median $25.70 Typical High $134.90 | Professional | 56 · Pre-op care only | $22.91 | $25.70 | $134.90 |
Where South Dakota sits
The same service costs 6.5 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
$1,413
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.