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 $239.88 Median $338.84 Typical High $4,365.16 | Facility | None | $239.88 | $338.84 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $199.53 Median $288.40 Typical High $363.08 | Professional | None | $199.53 | $288.40 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $954.99 Typical High $1,047.13 | Facility | None | $501.19 | $954.99 | $1,047.13 |
Cigna Setting Professional Modifier None Typical Low $489.78 Median $691.83 Typical High $977.24 | Professional | None | $489.78 | $691.83 | $977.24 |
Medica Setting Facility Modifier None Typical Low $338.84 Median $489.78 Typical High $1,202.26 | Facility | None | $338.84 | $489.78 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $295.12 Median $776.25 Typical High $2,511.89 | Professional | None | $295.12 | $776.25 | $2,511.89 |
Midlands Setting Professional Modifier None Typical Low $549.54 Median $549.54 Typical High $776.25 | Professional | None | $549.54 | $549.54 | $776.25 |
Midlands Setting Facility Modifier None Typical Low $812.83 Median $954.99 Typical High $1,202.26 | Facility | None | $812.83 | $954.99 | $1,202.26 |
Midlands Setting Professional Modifier None Typical Low $489.78 Median $489.78 Typical High $691.83 | Professional | None | $489.78 | $489.78 | $691.83 |
Sanford Health Plan Setting Professional Modifier None Typical Low $346.74 Median $467.74 Typical High $660.69 | Professional | None | $346.74 | $467.74 | $660.69 |
United Setting Facility Modifier None Typical Low $758.58 Median $891.25 Typical High $1,698.24 | Facility | None | $758.58 | $891.25 | $1,698.24 |
United Setting Professional Modifier None Typical Low $281.84 Median $501.19 Typical High $933.25 | Professional | None | $281.84 | $501.19 | $933.25 |
Wellmark Setting Professional Modifier None Typical Low $407.38 Median $467.74 Typical High $776.25 | Professional | None | $407.38 | $467.74 | $776.25 |
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 $100.00 Median $144.54 Typical High $169.82 | Professional | 52 · Reduced service | $100.00 | $144.54 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $57.54 Typical High $67.61 | Professional | 53 · Discontinued | $39.81 | $57.54 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $213.80 Typical High $257.04 | Professional | 54 · Surgery only | $147.91 | $213.80 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $43.65 Typical High $51.29 | Professional | 55 · Aftercare only | $29.51 | $43.65 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $28.84 Typical High $33.88 | Professional | 56 · Pre-op care only | $19.95 | $28.84 | $33.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $199.53 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $138.04 | $199.53 | $239.88 |
Where South Dakota sits
The same service costs 4.0 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· 5th of 51
$550
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.