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 $70.79 Median $190.55 Typical High $4,365.16 | Facility | None | $70.79 | $190.55 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $66.07 Median $112.20 Typical High $239.88 | Professional | None | $66.07 | $112.20 | $239.88 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $263.03 Typical High $457.09 | Professional | None | $134.90 | $263.03 | $457.09 |
Medica Setting Facility Modifier None Typical Low $95.50 Median $245.47 Typical High $478.63 | Facility | None | $95.50 | $245.47 | $478.63 |
Medica Setting Professional Modifier None Typical Low $165.96 Median $446.68 Typical High $1,258.93 | Professional | None | $165.96 | $446.68 | $1,258.93 |
Midlands Setting Professional Modifier None Typical Low $165.96 Median $380.19 Typical High $446.68 | Professional | None | $165.96 | $380.19 | $446.68 |
Sanford Health Plan Setting Professional Modifier None Typical Low $100.00 Median $223.87 Typical High $338.84 | Professional | None | $100.00 | $223.87 | $338.84 |
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 $87.10 Median $194.98 Typical High $524.81 | Professional | None | $87.10 | $194.98 | $524.81 |
Wellmark Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $436.52 | Professional | None | $158.49 | $158.49 | $436.52 |
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 $33.11 Median $56.23 Typical High $95.50 | Professional | 52 · Reduced service | $33.11 | $56.23 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $22.39 Typical High $38.90 | Professional | 53 · Discontinued | $13.18 | $22.39 | $38.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $50.12 Median $83.18 Typical High $144.54 | Professional | 54 · Surgery only | $50.12 | $83.18 | $144.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $16.60 Typical High $28.84 | Professional | 55 · Aftercare only | $10.00 | $16.60 | $28.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $11.22 Typical High $19.50 | Professional | 56 · Pre-op care only | $6.61 | $11.22 | $19.50 |
Where South Dakota sits
The same service costs 2.7 times more in Wisconsin than in Utah. 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
$234
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.