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 $275.42 Median $275.42 Typical High $281.84 | Facility | None | $275.42 | $275.42 | $281.84 |
Aetna Setting Professional Modifier None Typical Low $275.42 Median $281.84 Typical High $302.00 | Professional | None | $275.42 | $281.84 | $302.00 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $354.81 Typical High $389.05 | Professional | None | $281.84 | $354.81 | $389.05 |
Medica Setting Facility Modifier None Typical Low $251.19 Median $436.52 Typical High $436.52 | Facility | None | $251.19 | $436.52 | $436.52 |
Medica Setting Professional Modifier None Typical Low $257.04 Median $288.40 Typical High $389.05 | Professional | None | $257.04 | $288.40 | $389.05 |
Midlands Setting Professional Modifier None Typical Low $323.59 Median $389.05 Typical High $389.05 | Professional | None | $323.59 | $389.05 | $389.05 |
Midlands Setting Professional Modifier None Typical Low $208.93 Median $208.93 Typical High $208.93 | Professional | None | $208.93 | $208.93 | $208.93 |
Sanford Health Plan Setting Professional Modifier None Typical Low $281.84 Median $309.03 Typical High $309.03 | Professional | None | $281.84 | $309.03 | $309.03 |
United Setting Professional Modifier None Typical Low $269.15 Median $275.42 Typical High $316.23 | Professional | None | $269.15 | $275.42 | $316.23 |
Wellmark Setting Facility Modifier None Typical Low $295.12 Median $295.12 Typical High $295.12 | Facility | None | $295.12 | $295.12 | $295.12 |
Wellmark Setting Professional Modifier None Typical Low $295.12 Median $295.12 Typical High $295.12 | Professional | None | $295.12 | $295.12 | $295.12 |
4 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 $138.04 Median $138.04 Typical High $138.04 | Professional | 52 · Reduced service | $138.04 | $138.04 | $138.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $54.95 Median $56.23 Typical High $56.23 | Professional | 53 · Discontinued | $54.95 | $56.23 | $56.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $40.74 Median $41.69 Typical High $41.69 | Professional | 55 · Aftercare only | $40.74 | $41.69 | $41.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $27.54 Median $28.18 Typical High $28.18 | Professional | 56 · Pre-op care only | $27.54 | $28.18 | $28.18 |
Where South Dakota sits
Rates are fairly even across states for this service. 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· 7th of 51
$295
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.