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 $154.88 Median $263.03 Typical High $4,365.16 | Facility | None | $154.88 | $263.03 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $223.87 Typical High $275.42 | Professional | None | $131.83 | $223.87 | $275.42 |
Cigna Setting Facility Modifier None Typical Low $389.05 Median $870.96 Typical High $1,047.13 | Facility | None | $389.05 | $870.96 | $1,047.13 |
Cigna Setting Professional Modifier None Typical Low $309.03 Median $457.09 Typical High $691.83 | Professional | None | $309.03 | $457.09 | $691.83 |
Medica Setting Facility Modifier None Typical Low $204.17 Median $389.05 Typical High $1,202.26 | Facility | None | $204.17 | $389.05 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $239.88 Median $660.69 Typical High $1,995.26 | Professional | None | $239.88 | $660.69 | $1,995.26 |
Midlands Setting Professional Modifier None Typical Low $363.08 Median $363.08 Typical High $588.84 | Professional | None | $363.08 | $363.08 | $588.84 |
Midlands Setting Facility Modifier None Typical Low $812.83 Median $1,000.00 Typical High $1,202.26 | Facility | None | $812.83 | $1,000.00 | $1,202.26 |
Midlands Setting Professional Modifier None Typical Low $323.59 Median $354.81 Typical High $588.84 | Professional | None | $323.59 | $354.81 | $588.84 |
Sanford Health Plan Setting Professional Modifier None Typical Low $204.17 Median $323.59 Typical High $489.78 | Professional | None | $204.17 | $323.59 | $489.78 |
United Setting Facility Modifier None Typical Low $758.58 Median $891.25 Typical High $1,698.24 | Facility | None | $758.58 | $891.25 | $1,698.24 |
United Setting Professional Modifier None Typical Low $186.21 Median $416.87 Typical High $741.31 | Professional | None | $186.21 | $416.87 | $741.31 |
Wellmark Setting Professional Modifier None Typical Low $309.03 Median $363.08 Typical High $691.83 | Professional | None | $309.03 | $363.08 | $691.83 |
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 $66.07 Median $114.82 Typical High $134.90 | Professional | 52 · Reduced service | $66.07 | $114.82 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $45.71 Typical High $53.70 | Professional | 53 · Discontinued | $26.30 | $45.71 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $173.78 Typical High $204.17 | Professional | 54 · Surgery only | $100.00 | $173.78 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $34.67 Typical High $40.74 | Professional | 55 · Aftercare only | $19.95 | $34.67 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $22.91 Typical High $26.92 | Professional | 56 · Pre-op care only | $13.18 | $22.91 | $26.92 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $93.33 Median $162.18 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $93.33 | $162.18 | $190.55 |
Where South Dakota sits
The same service costs 4.5 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· 7th of 51
$389
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.