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 $234.42 Median $234.42 Typical High $4,365.16 | Facility | None | $234.42 | $234.42 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $190.55 Median $190.55 Typical High $234.42 | Professional | None | $190.55 | $190.55 | $234.42 |
Cigna Setting Facility Modifier None Typical Low $323.59 Median $323.59 Typical High $407.38 | Facility | None | $323.59 | $323.59 | $407.38 |
Cigna Setting Professional Modifier None Typical Low $371.54 Median $537.03 Typical High $645.65 | Professional | None | $371.54 | $537.03 | $645.65 |
Medica Setting Facility Modifier None Typical Low $302.00 Median $524.81 Typical High $1,202.26 | Facility | None | $302.00 | $524.81 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $257.04 Median $549.54 Typical High $4,365.16 | Professional | None | $257.04 | $549.54 | $4,365.16 |
Midlands Setting Professional Modifier None Typical Low $537.03 Median $549.54 Typical High $549.54 | Professional | None | $537.03 | $549.54 | $549.54 |
Midlands Setting Professional Modifier None Typical Low $512.86 Median $512.86 Typical High $512.86 | Professional | None | $512.86 | $512.86 | $512.86 |
Sanford Health Plan Setting Professional Modifier None Typical Low $288.40 Median $346.74 Typical High $467.74 | Professional | None | $288.40 | $346.74 | $467.74 |
United Setting Facility Modifier None Typical Low $758.58 Median $758.58 Typical High $1,202.26 | Facility | None | $758.58 | $758.58 | $1,202.26 |
United Setting Professional Modifier None Typical Low $234.42 Median $467.74 Typical High $645.65 | Professional | None | $234.42 | $467.74 | $645.65 |
Wellmark Setting Professional Modifier None Typical Low $478.63 Median $562.34 Typical High $562.34 | Professional | None | $478.63 | $562.34 | $562.34 |
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 $95.50 Median $95.50 Typical High $117.49 | Professional | 52 · Reduced service | $95.50 | $95.50 | $117.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $38.90 Typical High $47.86 | Professional | 53 · Discontinued | $38.90 | $38.90 | $47.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $144.54 Typical High $177.83 | Professional | 54 · Surgery only | $144.54 | $144.54 | $177.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $28.84 Typical High $35.48 | Professional | 55 · Aftercare only | $28.84 | $28.84 | $35.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $19.05 Typical High $23.44 | Professional | 56 · Pre-op care only | $19.05 | $19.05 | $23.44 |
Where South Dakota sits
The same service costs 5.0 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
$513
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.