How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $15.85 Median $15.85 Typical High $30.20 | Facility | None | $15.85 | $15.85 | $30.20 |
Aetna Setting Professional Modifier None Typical Low $14.79 Median $28.18 Typical High $42.66 | Professional | None | $14.79 | $28.18 | $42.66 |
Cigna Setting Facility Modifier None Typical Low $40.74 Median $40.74 Typical High $51.29 | Facility | None | $40.74 | $40.74 | $51.29 |
Cigna Setting Professional Modifier None Typical Low $34.67 Median $46.77 Typical High $81.28 | Professional | None | $34.67 | $46.77 | $81.28 |
Medica Setting Facility Modifier None Typical Low $25.12 Median $47.86 Typical High $194.98 | Facility | None | $25.12 | $47.86 | $194.98 |
Medica Setting Professional Modifier None Typical Low $31.62 Median $67.61 Typical High $204.17 | Professional | None | $31.62 | $67.61 | $204.17 |
Midlands Setting Professional Modifier None Typical Low $37.15 Median $37.15 Typical High $70.79 | Professional | None | $37.15 | $37.15 | $70.79 |
Sanford Health Plan Setting Professional Modifier None Typical Low $23.99 Median $38.02 Typical High $52.48 | Professional | None | $23.99 | $38.02 | $52.48 |
United Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $223.87 | Facility | None | $125.89 | $125.89 | $223.87 |
United Setting Professional Modifier None Typical Low $18.62 Median $43.65 Typical High $85.11 | Professional | None | $18.62 | $43.65 | $85.11 |
Wellmark Setting Professional Modifier None Typical Low $26.92 Median $33.11 Typical High $69.18 | Professional | None | $26.92 | $33.11 | $69.18 |
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 $7.41 Median $12.88 Typical High $15.85 | Professional | 52 · Reduced service | $7.41 | $12.88 | $15.85 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.02 Median $5.13 Typical High $6.31 | Professional | 53 · Discontinued | $3.02 | $5.13 | $6.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $11.22 Median $19.50 Typical High $23.99 | Professional | 54 · Surgery only | $11.22 | $19.50 | $23.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.24 Median $3.89 Typical High $4.79 | Professional | 55 · Aftercare only | $2.24 | $3.89 | $4.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.51 Median $2.57 Typical High $3.16 | Professional | 56 · Pre-op care only | $1.51 | $2.57 | $3.16 |
Where South Dakota sits
The same service costs 3.5 times more in Wisconsin than in Kentucky. 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· 11th of 51
$42.66
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.