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 $102.33 Median $2,238.72 Typical High $2,290.87 | Facility | None | $102.33 | $2,238.72 | $2,290.87 |
Aetna Setting Professional Modifier None Typical Low $25.70 Median $87.10 Typical High $120.23 | Professional | None | $25.70 | $87.10 | $120.23 |
Cigna Setting Facility Modifier None Typical Low $131.83 Median $138.04 Typical High $190.55 | Facility | None | $131.83 | $138.04 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $70.79 Median $173.78 Typical High $302.00 | Professional | None | $70.79 | $173.78 | $302.00 |
Medica Setting Facility Modifier None Typical Low $42.66 Median $125.89 Typical High $223.87 | Facility | None | $42.66 | $125.89 | $223.87 |
Medica Setting Professional Modifier None Typical Low $97.72 Median $269.15 Typical High $812.83 | Professional | None | $97.72 | $269.15 | $812.83 |
Midlands Setting Professional Modifier None Typical Low $72.44 Median $72.44 Typical High $229.09 | Professional | None | $72.44 | $72.44 | $229.09 |
Midlands Setting Facility Modifier None Typical Low $120.23 Median $134.90 Typical High $173.78 | Facility | None | $120.23 | $134.90 | $173.78 |
Midlands Setting Professional Modifier None Typical Low $63.10 Median $63.10 Typical High $204.17 | Professional | None | $63.10 | $63.10 | $204.17 |
Sanford Health Plan Setting Professional Modifier None Typical Low $40.74 Median $125.89 Typical High $194.98 | Professional | None | $40.74 | $125.89 | $194.98 |
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 $39.81 Median $87.10 Typical High $281.84 | Professional | None | $39.81 | $87.10 | $281.84 |
Wellmark Setting Professional Modifier None Typical Low $63.10 Median $74.13 Typical High $257.04 | Professional | None | $63.10 | $74.13 | $257.04 |
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 $12.59 Median $15.14 Typical High $50.12 | Professional | 52 · Reduced service | $12.59 | $15.14 | $50.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.13 Median $6.03 Typical High $19.95 | Professional | 53 · Discontinued | $5.13 | $6.03 | $19.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $19.05 Median $22.91 Typical High $74.13 | Professional | 54 · Surgery only | $19.05 | $22.91 | $74.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.80 Median $4.57 Typical High $14.79 | Professional | 55 · Aftercare only | $3.80 | $4.57 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.51 Median $3.02 Typical High $10.00 | Professional | 56 · Pre-op care only | $2.51 | $3.02 | $10.00 |
Where South Dakota sits
The same service costs 5.4 times more in Wisconsin than in Hawaii. 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· 12th of 51
$126
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.