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 $120.23 Median $2,290.87 Typical High $4,365.16 | Facility | None | $120.23 | $2,290.87 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $102.33 Median $102.33 Typical High $120.23 | Professional | None | $102.33 | $102.33 | $120.23 |
Cigna Setting Facility Modifier None Typical Low $177.83 Median $891.25 Typical High $1,659.59 | Facility | None | $177.83 | $891.25 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $199.53 Median $275.42 Typical High $354.81 | Professional | None | $199.53 | $275.42 | $354.81 |
Medica Setting Facility Modifier None Typical Low $147.91 Median $281.84 Typical High $1,202.26 | Facility | None | $147.91 | $281.84 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $128.82 Median $275.42 Typical High $891.25 | Professional | None | $128.82 | $275.42 | $891.25 |
Midlands Setting Professional Modifier None Typical Low $245.47 Median $275.42 Typical High $275.42 | Professional | None | $245.47 | $275.42 | $275.42 |
Midlands Setting Facility Modifier None Typical Low $851.14 Median $1,071.52 Typical High $1,659.59 | Facility | None | $851.14 | $1,071.52 | $1,659.59 |
Midlands Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $158.49 | Professional | None | $158.49 | $158.49 | $158.49 |
Sanford Health Plan Setting Professional Modifier None Typical Low $57.54 Median $57.54 Typical High $57.54 | Professional | None | $57.54 | $57.54 | $57.54 |
United Setting Facility Modifier None Typical Low $758.58 Median $891.25 Typical High $1,698.24 | Facility | None | $758.58 | $891.25 | $1,698.24 |
United Setting Professional Modifier None Typical Low $117.49 Median $234.42 Typical High $331.13 | Professional | None | $117.49 | $234.42 | $331.13 |
Wellmark Setting Professional Modifier None Typical Low $66.07 Median $66.07 Typical High $66.07 | Professional | None | $66.07 | $66.07 | $66.07 |
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 $51.29 Median $51.29 Typical High $60.26 | Professional | 52 · Reduced service | $51.29 | $51.29 | $60.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $20.42 Typical High $23.99 | Professional | 53 · Discontinued | $20.42 | $20.42 | $23.99 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $77.62 Typical High $89.13 | Professional | 54 · Surgery only | $77.62 | $77.62 | $89.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $15.49 Typical High $18.20 | Professional | 55 · Aftercare only | $15.49 | $15.49 | $18.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $10.23 Typical High $12.02 | Professional | 56 · Pre-op care only | $10.23 | $10.23 | $12.02 |
Where South Dakota sits
The same service costs 6.0 times more in Alaska 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· 5th of 51
$275
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.