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 $69.18 Median $204.17 Typical High $4,365.16 | Facility | None | $69.18 | $204.17 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $66.07 Median $85.11 Typical High $229.09 | Professional | None | $66.07 | $85.11 | $229.09 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $177.83 Typical High $549.54 | Professional | None | $134.90 | $177.83 | $549.54 |
Medica Setting Facility Modifier None Typical Low $95.50 Median $229.09 Typical High $363.08 | Facility | None | $95.50 | $229.09 | $363.08 |
Medica Setting Professional Modifier None Typical Low $158.49 Median $380.19 Typical High $1,230.27 | Professional | None | $158.49 | $380.19 | $1,230.27 |
Midlands Setting Professional Modifier None Typical Low $134.90 Median $169.82 Typical High $363.08 | Professional | None | $134.90 | $169.82 | $363.08 |
Midlands Setting Professional Modifier None Typical Low $138.04 Median $141.25 Typical High $407.38 | Professional | None | $138.04 | $141.25 | $407.38 |
Sanford Health Plan Setting Professional Modifier None Typical Low $95.50 Median $204.17 Typical High $371.54 | Professional | None | $95.50 | $204.17 | $371.54 |
United Setting Professional Modifier None Typical Low $85.11 Median $158.49 Typical High $426.58 | Professional | None | $85.11 | $158.49 | $426.58 |
Wellmark Setting Professional Modifier None Typical Low $79.43 Median $97.72 Typical High $363.08 | Professional | None | $79.43 | $97.72 | $363.08 |
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 $33.11 Median $37.15 Typical High $102.33 | Professional | 52 · Reduced service | $33.11 | $37.15 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $14.79 Typical High $40.74 | Professional | 53 · Discontinued | $13.18 | $14.79 | $40.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $50.12 Median $54.95 Typical High $151.36 | Professional | 54 · Surgery only | $50.12 | $54.95 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $10.96 Typical High $30.20 | Professional | 55 · Aftercare only | $10.00 | $10.96 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $7.41 Typical High $20.42 | Professional | 56 · Pre-op care only | $6.61 | $7.41 | $20.42 |
Where South Dakota sits
The same service costs 2.9 times more in Washington 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
$209
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.