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 $107.15 Median $165.96 Typical High $4,365.16 | Facility | None | $107.15 | $165.96 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $144.54 Typical High $181.97 | Professional | None | $89.13 | $144.54 | $181.97 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $144.54 Typical High $309.03 | Facility | None | $100.00 | $144.54 | $309.03 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $309.03 Typical High $426.58 | Professional | None | $218.78 | $309.03 | $426.58 |
Medica Setting Facility Modifier None Typical Low $125.89 Median $151.36 Typical High $245.47 | Facility | None | $125.89 | $151.36 | $245.47 |
Medica Setting Professional Modifier None Typical Low $144.54 Median $371.54 Typical High $1,258.93 | Professional | None | $144.54 | $371.54 | $1,258.93 |
Midlands Setting Professional Modifier None Typical Low $251.19 Median $251.19 Typical High $371.54 | Professional | None | $251.19 | $251.19 | $371.54 |
Midlands Setting Facility Modifier None Typical Low $100.00 Median $141.25 Typical High $173.78 | Facility | None | $100.00 | $141.25 | $173.78 |
Midlands Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $338.84 | Professional | None | $218.78 | $218.78 | $338.84 |
Sanford Health Plan Setting Professional Modifier None Typical Low $165.96 Median $223.87 Typical High $323.59 | Professional | None | $165.96 | $223.87 | $323.59 |
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 $128.82 Median $251.19 Typical High $457.09 | Professional | None | $128.82 | $251.19 | $457.09 |
Wellmark Setting Professional Modifier None Typical Low $177.83 Median $204.17 Typical High $371.54 | Professional | None | $177.83 | $204.17 | $371.54 |
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 $44.67 Median $72.44 Typical High $83.18 | Professional | 52 · Reduced service | $44.67 | $72.44 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.78 Median $28.84 Typical High $33.88 | Professional | 53 · Discontinued | $17.78 | $28.84 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $107.15 Typical High $125.89 | Professional | 54 · Surgery only | $67.61 | $107.15 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $21.38 Typical High $25.12 | Professional | 55 · Aftercare only | $13.49 | $21.38 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $14.45 Typical High $16.60 | Professional | 56 · Pre-op care only | $8.91 | $14.45 | $16.60 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $100.00 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $63.10 | $100.00 | $117.49 |
Where South Dakota sits
The same service costs 3.5 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
$251
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.