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 $47.86 Median $380.19 Typical High $489.78 | Facility | None | $47.86 | $380.19 | $489.78 |
Aetna Setting Professional Modifier None Typical Low $58.88 Median $100.00 Typical High $151.36 | Professional | None | $58.88 | $100.00 | $151.36 |
Cigna Setting Facility Modifier None Typical Low $66.07 Median $169.82 Typical High $213.80 | Facility | None | $66.07 | $169.82 | $213.80 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $208.93 Typical High $338.84 | Professional | None | $147.91 | $208.93 | $338.84 |
Medica Setting Facility Modifier None Typical Low $100.00 Median $125.89 Typical High $223.87 | Facility | None | $100.00 | $125.89 | $223.87 |
Medica Setting Professional Modifier None Typical Low $100.00 Median $245.47 Typical High $512.86 | Professional | None | $100.00 | $245.47 | $512.86 |
Midlands Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $251.19 | Professional | None | $158.49 | $158.49 | $251.19 |
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 $138.04 Median $138.04 Typical High $229.09 | Professional | None | $138.04 | $138.04 | $229.09 |
Sanford Health Plan Setting Professional Modifier None Typical Low $104.71 Median $147.91 Typical High $218.78 | Professional | None | $104.71 | $147.91 | $218.78 |
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 $79.43 Median $169.82 Typical High $316.23 | Professional | None | $79.43 | $169.82 | $316.23 |
Wellmark Setting Professional Modifier None Typical Low $123.03 Median $144.54 Typical High $257.04 | Professional | None | $123.03 | $144.54 | $257.04 |
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 $29.51 Median $50.12 Typical High $57.54 | Professional | 52 · Reduced service | $29.51 | $50.12 | $57.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.75 Median $19.95 Typical High $22.91 | Professional | 53 · Discontinued | $11.75 | $19.95 | $22.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $44.67 Median $74.13 Typical High $87.10 | Professional | 54 · Surgery only | $44.67 | $74.13 | $87.10 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.91 Median $14.79 Typical High $17.38 | Professional | 55 · Aftercare only | $8.91 | $14.79 | $17.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.89 Median $10.00 Typical High $11.48 | Professional | 56 · Pre-op care only | $5.89 | $10.00 | $11.48 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $41.69 Median $69.18 Typical High $81.28 | Professional | 78 · Unplanned return to OR | $41.69 | $69.18 | $81.28 |
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· 6th of 51
$166
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.