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 $512.86 Median $707.95 Typical High $4,365.16 | Facility | None | $512.86 | $707.95 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $407.38 Median $575.44 Typical High $794.33 | Professional | None | $407.38 | $575.44 | $794.33 |
Cigna Setting Facility Modifier None Typical Low $162.18 Median $457.09 Typical High $1,288.25 | Facility | None | $162.18 | $457.09 | $1,288.25 |
Cigna Setting Professional Modifier None Typical Low $1,047.13 Median $1,412.54 Typical High $1,737.80 | Professional | None | $1,047.13 | $1,412.54 | $1,737.80 |
Medica Setting Facility Modifier None Typical Low $125.89 Median $691.83 Typical High $977.24 | Facility | None | $125.89 | $691.83 | $977.24 |
Medica Setting Professional Modifier None Typical Low $676.08 Median $1,862.09 Typical High $5,128.61 | Professional | None | $676.08 | $1,862.09 | $5,128.61 |
Midlands Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,659.59 | Professional | None | $1,258.93 | $1,258.93 | $1,659.59 |
Midlands Setting Facility Modifier None Typical Low $158.49 Median $208.93 Typical High $630.96 | Facility | None | $158.49 | $208.93 | $630.96 |
Midlands Setting Professional Modifier None Typical Low $1,071.52 Median $1,258.93 Typical High $1,698.24 | Professional | None | $1,071.52 | $1,258.93 | $1,698.24 |
Sanford Health Plan Setting Professional Modifier None Typical Low $707.95 Median $1,000.00 Typical High $1,318.26 | Professional | None | $707.95 | $1,000.00 | $1,318.26 |
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 $616.60 Median $1,380.38 Typical High $1,995.26 | Professional | None | $616.60 | $1,380.38 | $1,995.26 |
Wellmark Setting Professional Modifier None Typical Low $933.25 Median $1,096.48 Typical High $1,819.70 | Professional | None | $933.25 | $1,096.48 | $1,819.70 |
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 $204.17 Median $288.40 Typical High $346.74 | Professional | 52 · Reduced service | $204.17 | $288.40 | $346.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $117.49 Typical High $141.25 | Professional | 53 · Discontinued | $81.28 | $117.49 | $141.25 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $302.00 Median $436.52 Typical High $524.81 | Professional | 54 · Surgery only | $302.00 | $436.52 | $524.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $87.10 Typical High $104.71 | Professional | 55 · Aftercare only | $61.66 | $87.10 | $104.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $57.54 Typical High $69.18 | Professional | 56 · Pre-op care only | $40.74 | $57.54 | $69.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $407.38 Typical High $489.78 | Professional | 78 · Unplanned return to OR | $281.84 | $407.38 | $489.78 |
Where South Dakota sits
The same service costs 3.6 times more in Alaska than in Maryland. 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
$1,148
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.