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 $134.90 Median $2,290.87 Typical High $4,365.16 | Facility | None | $134.90 | $2,290.87 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $112.20 Median $112.20 Typical High $134.90 | Professional | None | $112.20 | $112.20 | $134.90 |
Cigna Setting Facility Modifier None Typical Low $194.98 Median $575.44 Typical High $1,122.02 | Facility | None | $194.98 | $575.44 | $1,122.02 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $316.23 Typical High $389.05 | Professional | None | $218.78 | $316.23 | $389.05 |
Medica Setting Facility Modifier None Typical Low $177.83 Median $407.38 Typical High $1,202.26 | Facility | None | $177.83 | $407.38 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $162.18 Median $316.23 Typical High $1,862.09 | Professional | None | $162.18 | $316.23 | $1,862.09 |
Midlands Setting Professional Modifier None Typical Low $302.00 Median $316.23 Typical High $316.23 | Professional | None | $302.00 | $316.23 | $316.23 |
Midlands Setting Facility Modifier None Typical Low $575.44 Median $645.65 Typical High $1,202.26 | Facility | None | $575.44 | $645.65 | $1,202.26 |
Midlands Setting Professional Modifier None Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | None | $281.84 | $281.84 | $281.84 |
Sanford Health Plan Setting Professional Modifier None Typical Low $169.82 Median $229.09 Typical High $346.74 | Professional | None | $169.82 | $229.09 | $346.74 |
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 $151.36 Median $275.42 Typical High $380.19 | Professional | None | $151.36 | $275.42 | $380.19 |
Wellmark Setting Professional Modifier None Typical Low $269.15 Median $309.03 Typical High $309.03 | Professional | None | $269.15 | $309.03 | $309.03 |
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 $56.23 Median $56.23 Typical High $67.61 | Professional | 52 · Reduced service | $56.23 | $56.23 | $67.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $22.91 Typical High $26.92 | Professional | 53 · Discontinued | $22.91 | $22.91 | $26.92 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $85.11 Typical High $102.33 | Professional | 54 · Surgery only | $85.11 | $85.11 | $102.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $16.98 Typical High $20.42 | Professional | 55 · Aftercare only | $16.98 | $16.98 | $20.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.22 Median $11.22 Typical High $13.49 | Professional | 56 · Pre-op care only | $11.22 | $11.22 | $13.49 |
Where South Dakota sits
The same service costs 5.4 times more in Alaska 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· 6th of 51
$309
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.