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 $42.66 Median $489.78 Typical High $489.78 | Facility | None | $42.66 | $489.78 | $489.78 |
Aetna Setting Professional Modifier None Typical Low $47.86 Median $58.88 Typical High $100.00 | Professional | None | $47.86 | $58.88 | $100.00 |
Cigna Setting Facility Modifier None Typical Low $66.07 Median $102.33 Typical High $128.82 | Facility | None | $66.07 | $102.33 | $128.82 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $144.54 Typical High $169.82 | Professional | None | $114.82 | $144.54 | $169.82 |
Medica Setting Facility Modifier None Typical Low $79.43 Median $100.00 Typical High $223.87 | Facility | None | $79.43 | $100.00 | $223.87 |
Medica Setting Professional Modifier None Typical Low $61.66 Median $138.04 Typical High $416.87 | Professional | None | $61.66 | $138.04 | $416.87 |
Midlands Setting Professional Modifier None Typical Low $123.03 Median $123.03 Typical High $147.91 | Professional | None | $123.03 | $123.03 | $147.91 |
Midlands Setting Facility Modifier None Typical Low $66.07 Median $66.07 Typical High $66.07 | Facility | None | $66.07 | $66.07 | $66.07 |
Midlands Setting Professional Modifier None Typical Low $109.65 Median $109.65 Typical High $134.90 | Professional | None | $109.65 | $109.65 | $134.90 |
Sanford Health Plan Setting Professional Modifier None Typical Low $70.79 Median $102.33 Typical High $131.83 | Professional | None | $70.79 | $102.33 | $131.83 |
United Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $223.87 | Facility | None | $125.89 | $125.89 | $223.87 |
United Setting Professional Modifier None Typical Low $56.23 Median $109.65 Typical High $181.97 | Professional | None | $56.23 | $109.65 | $181.97 |
Wellmark Setting Professional Modifier None Typical Low $95.50 Median $109.65 Typical High $151.36 | Professional | None | $95.50 | $109.65 | $151.36 |
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 $23.99 Median $29.51 Typical High $37.15 | Professional | 52 · Reduced service | $23.99 | $29.51 | $37.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.55 Median $11.75 Typical High $15.14 | Professional | 53 · Discontinued | $9.55 | $11.75 | $15.14 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $43.65 Typical High $56.23 | Professional | 54 · Surgery only | $35.48 | $43.65 | $56.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $8.71 Typical High $11.22 | Professional | 55 · Aftercare only | $7.08 | $8.71 | $11.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.79 Median $5.89 Typical High $7.41 | Professional | 56 · Pre-op care only | $4.79 | $5.89 | $7.41 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $33.11 Median $40.74 Typical High $52.48 | Professional | 78 · Unplanned return to OR | $33.11 | $40.74 | $52.48 |
Where South Dakota sits
The same service costs 4.2 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
$123
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.