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 $48.98 Median $52.48 Typical High $4,365.16 | Facility | None | $48.98 | $52.48 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $41.69 Median $46.77 Typical High $67.61 | Professional | None | $41.69 | $46.77 | $67.61 |
Cigna Setting Facility Modifier None Typical Low $26.30 Median $77.62 Typical High $97.72 | Facility | None | $26.30 | $77.62 | $97.72 |
Cigna Setting Professional Modifier None Typical Low $87.10 Median $114.82 Typical High $144.54 | Professional | None | $87.10 | $114.82 | $144.54 |
Medica Setting Facility Modifier None Typical Low $64.57 Median $75.86 Typical High $151.36 | Facility | None | $64.57 | $75.86 | $151.36 |
Medica Setting Professional Modifier None Typical Low $46.77 Median $125.89 Typical High $389.05 | Professional | None | $46.77 | $125.89 | $389.05 |
Midlands Setting Professional Modifier None Typical Low $107.15 Median $112.20 Typical High $120.23 | Professional | None | $107.15 | $112.20 | $120.23 |
Midlands Setting Facility Modifier None Typical Low $26.30 Median $26.30 Typical High $26.30 | Facility | None | $26.30 | $26.30 | $26.30 |
Midlands Setting Professional Modifier None Typical Low $100.00 Median $100.00 Typical High $107.15 | Professional | None | $100.00 | $100.00 | $107.15 |
Sanford Health Plan Setting Professional Modifier None Typical Low $58.88 Median $85.11 Typical High $104.71 | Professional | None | $58.88 | $85.11 | $104.71 |
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 $44.67 Median $97.72 Typical High $144.54 | Professional | None | $44.67 | $97.72 | $144.54 |
Wellmark Setting Professional Modifier None Typical Low $83.18 Median $95.50 Typical High $120.23 | Professional | None | $83.18 | $95.50 | $120.23 |
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 $20.89 Median $22.39 Typical High $33.88 | Professional | 52 · Reduced service | $20.89 | $22.39 | $33.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.32 Median $8.91 Typical High $13.49 | Professional | 53 · Discontinued | $8.32 | $8.91 | $13.49 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $30.90 Median $33.11 Typical High $50.12 | Professional | 54 · Surgery only | $30.90 | $33.11 | $50.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.17 Median $6.76 Typical High $10.00 | Professional | 55 · Aftercare only | $6.17 | $6.76 | $10.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.17 Median $4.47 Typical High $6.76 | Professional | 56 · Pre-op care only | $4.17 | $4.47 | $6.76 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $28.84 Median $30.90 Typical High $46.77 | Professional | 78 · Unplanned return to OR | $28.84 | $30.90 | $46.77 |
Where South Dakota sits
The same service costs 4.6 times more in Alaska than in New York. 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
$102
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.