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 $95.50 Median $186.21 Typical High $4,365.16 | Facility | None | $95.50 | $186.21 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $81.28 Median $165.96 Typical High $199.53 | Professional | None | $81.28 | $165.96 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $309.03 Median $1,412.54 Typical High $1,862.09 | Facility | None | $309.03 | $1,412.54 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $199.53 Median $302.00 Typical High $524.81 | Professional | None | $199.53 | $302.00 | $524.81 |
Medica Setting Facility Modifier None Typical Low $138.04 Median $309.03 Typical High $1,698.24 | Facility | None | $138.04 | $309.03 | $1,698.24 |
Medica Setting Professional Modifier None Typical Low $194.98 Median $398.11 Typical High $1,548.82 | Professional | None | $194.98 | $398.11 | $1,548.82 |
Midlands Setting Professional Modifier None Typical Low $223.87 Median $245.47 Typical High $398.11 | Professional | None | $223.87 | $245.47 | $398.11 |
Midlands Setting Facility Modifier None Typical Low $645.65 Median $1,412.54 Typical High $1,949.84 | Facility | None | $645.65 | $1,412.54 | $1,949.84 |
Midlands Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $389.05 | Professional | None | $204.17 | $204.17 | $389.05 |
Sanford Health Plan Setting Professional Modifier None Typical Low $147.91 Median $229.09 Typical High $389.05 | Professional | None | $147.91 | $229.09 | $389.05 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $1,513.56 Typical High $1,819.70 | Facility | None | $1,513.56 | $1,513.56 | $1,819.70 |
United Setting Professional Modifier None Typical Low $114.82 Median $257.04 Typical High $524.81 | Professional | None | $114.82 | $257.04 | $524.81 |
Wellmark Setting Professional Modifier None Typical Low $213.80 Median $245.47 Typical High $602.56 | Professional | None | $213.80 | $245.47 | $602.56 |
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 $40.74 Median $81.28 Typical High $100.00 | Professional | 52 · Reduced service | $40.74 | $81.28 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.22 Median $33.11 Typical High $39.81 | Professional | 53 · Discontinued | $16.22 | $33.11 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $123.03 Typical High $151.36 | Professional | 54 · Surgery only | $61.66 | $123.03 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $24.55 Typical High $30.20 | Professional | 55 · Aftercare only | $12.30 | $24.55 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $16.60 Typical High $19.95 | Professional | 56 · Pre-op care only | $8.13 | $16.60 | $19.95 |
Where South Dakota sits
The same service costs 4.0 times more in Alaska than in Washington, DC. 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· 10th 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.