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 $89.13 Median $125.89 Typical High $4,365.16 | Facility | None | $89.13 | $125.89 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $74.13 Median $104.71 Typical High $190.55 | Professional | None | $74.13 | $104.71 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $66.07 Median $102.33 Typical High $239.88 | Facility | None | $66.07 | $102.33 | $239.88 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $251.19 Typical High $389.05 | Professional | None | $204.17 | $251.19 | $389.05 |
Medica Setting Facility Modifier None Typical Low $125.89 Median $158.49 Typical High $223.87 | Facility | None | $125.89 | $158.49 | $223.87 |
Medica Setting Professional Modifier None Typical Low $114.82 Median $331.13 Typical High $1,000.00 | Professional | None | $114.82 | $331.13 | $1,000.00 |
Midlands Setting Professional Modifier None Typical Low $208.93 Median $208.93 Typical High $275.42 | Professional | None | $208.93 | $208.93 | $275.42 |
Midlands Setting Facility Modifier None Typical Low $66.07 Median $87.10 Typical High $123.03 | Facility | None | $66.07 | $87.10 | $123.03 |
Midlands Setting Professional Modifier None Typical Low $190.55 Median $190.55 Typical High $263.03 | Professional | None | $190.55 | $190.55 | $263.03 |
Sanford Health Plan Setting Professional Modifier None Typical Low $131.83 Median $181.97 Typical High $245.47 | Professional | None | $131.83 | $181.97 | $245.47 |
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 $107.15 Median $239.88 Typical High $346.74 | Professional | None | $107.15 | $239.88 | $346.74 |
Wellmark Setting Professional Modifier None Typical Low $162.18 Median $199.53 Typical High $338.84 | Professional | None | $162.18 | $199.53 | $338.84 |
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 $37.15 Median $44.67 Typical High $61.66 | Professional | 52 · Reduced service | $37.15 | $44.67 | $61.66 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.14 Median $17.78 Typical High $24.55 | Professional | 53 · Discontinued | $15.14 | $17.78 | $24.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $56.23 Median $67.61 Typical High $93.33 | Professional | 54 · Surgery only | $56.23 | $67.61 | $93.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.22 Median $13.49 Typical High $18.62 | Professional | 55 · Aftercare only | $11.22 | $13.49 | $18.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.41 Median $8.91 Typical High $12.30 | Professional | 56 · Pre-op care only | $7.41 | $8.91 | $12.30 |
Where South Dakota sits
The same service costs 3.3 times more in Wisconsin 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· 8th of 51
$204
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.