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 $144.54 Median $190.55 Typical High $4,365.16 | Facility | None | $144.54 | $190.55 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $125.89 Median $165.96 Typical High $218.78 | Professional | None | $125.89 | $165.96 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $147.91 Median $190.55 Typical High $363.08 | Facility | None | $147.91 | $190.55 | $363.08 |
Cigna Setting Professional Modifier None Typical Low $309.03 Median $426.58 Typical High $575.44 | Professional | None | $309.03 | $426.58 | $575.44 |
Medica Setting Facility Modifier None Typical Low $194.98 Median $281.84 Typical High $549.54 | Facility | None | $194.98 | $281.84 | $549.54 |
Medica Setting Professional Modifier None Typical Low $169.82 Median $426.58 Typical High $1,445.44 | Professional | None | $169.82 | $426.58 | $1,445.44 |
Midlands Setting Professional Modifier None Typical Low $331.13 Median $331.13 Typical High $426.58 | Professional | None | $331.13 | $331.13 | $426.58 |
Midlands Setting Facility Modifier None Typical Low $147.91 Median $181.97 Typical High $208.93 | Facility | None | $147.91 | $181.97 | $208.93 |
Midlands Setting Professional Modifier None Typical Low $302.00 Median $302.00 Typical High $380.19 | Professional | None | $302.00 | $302.00 | $380.19 |
Sanford Health Plan Setting Professional Modifier None Typical Low $190.55 Median $281.84 Typical High $380.19 | Professional | None | $190.55 | $281.84 | $380.19 |
United Setting Facility Modifier None Typical Low $446.68 Median $537.03 Typical High $758.58 | Facility | None | $446.68 | $537.03 | $758.58 |
United Setting Professional Modifier None Typical Low $158.49 Median $302.00 Typical High $537.03 | Professional | None | $158.49 | $302.00 | $537.03 |
Wellmark Setting Professional Modifier None Typical Low $263.03 Median $302.00 Typical High $446.68 | Professional | None | $263.03 | $302.00 | $446.68 |
6 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 $63.10 Median $83.18 Typical High $100.00 | Professional | 52 · Reduced service | $63.10 | $83.18 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $33.11 Typical High $39.81 | Professional | 53 · Discontinued | $25.12 | $33.11 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $125.89 Typical High $151.36 | Professional | 54 · Surgery only | $93.33 | $125.89 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $25.12 Typical High $30.20 | Professional | 55 · Aftercare only | $19.05 | $25.12 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $16.60 Typical High $19.95 | Professional | 56 · Pre-op care only | $12.59 | $16.60 | $19.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $87.10 Median $117.49 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $87.10 | $117.49 | $141.25 |
Where South Dakota sits
The same service costs 3.9 times more in Alaska 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· 4th of 51
$331
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.