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 $107.15 Median $107.15 Typical High $107.15 | Facility | None | $107.15 | $107.15 | $107.15 |
Aetna Setting Professional Modifier None Typical Low $100.00 Median $100.00 Typical High $109.65 | Professional | None | $100.00 | $100.00 | $109.65 |
Cigna Setting Facility Modifier None Typical Low $229.09 Median $229.09 Typical High $281.84 | Facility | None | $229.09 | $229.09 | $281.84 |
Cigna Setting Professional Modifier None Typical Low $162.18 Median $169.82 Typical High $213.80 | Professional | None | $162.18 | $169.82 | $213.80 |
Medica Setting Facility Modifier None Typical Low $147.91 Median $169.82 Typical High $194.98 | Facility | None | $147.91 | $169.82 | $194.98 |
Medica Setting Professional Modifier None Typical Low $58.88 Median $74.13 Typical High $1,288.25 | Professional | None | $58.88 | $74.13 | $1,288.25 |
Midlands Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
Midlands Setting Professional Modifier None Typical Low $134.90 Median $134.90 Typical High $263.03 | Professional | None | $134.90 | $134.90 | $263.03 |
Sanford Health Plan Setting Professional Modifier None Typical Low $125.89 Median $147.91 Typical High $186.21 | Professional | None | $125.89 | $147.91 | $186.21 |
United Setting Professional Modifier None Typical Low $48.98 Median $58.88 Typical High $123.03 | Professional | None | $48.98 | $58.88 | $123.03 |
Wellmark Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $120.23 | Professional | None | $120.23 | $120.23 | $120.23 |
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 $50.12 Median $50.12 Typical High $54.95 | Professional | 52 · Reduced service | $50.12 | $50.12 | $54.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $19.95 Typical High $21.88 | Professional | 53 · Discontinued | $19.95 | $19.95 | $21.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $75.86 Typical High $81.28 | Professional | 54 · Surgery only | $75.86 | $75.86 | $81.28 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $15.14 Typical High $16.22 | Professional | 55 · Aftercare only | $15.14 | $15.14 | $16.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $10.00 Typical High $10.96 | Professional | 56 · Pre-op care only | $10.00 | $10.00 | $10.96 |
Where South Dakota sits
The same service costs 2.8 times more in Hawaii than in New York. 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· 14th of 51
$126
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.