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 $288.40 Median $446.68 Typical High $4,365.16 | Facility | None | $288.40 | $446.68 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $245.47 Median $363.08 Typical High $446.68 | Professional | None | $245.47 | $363.08 | $446.68 |
Cigna Setting Facility Modifier None Typical Low $346.74 Median $426.58 Typical High $794.33 | Facility | None | $346.74 | $426.58 | $794.33 |
Cigna Setting Professional Modifier None Typical Low $562.34 Median $851.14 Typical High $1,122.02 | Professional | None | $562.34 | $851.14 | $1,122.02 |
Medica Setting Facility Modifier None Typical Low $398.11 Median $630.96 Typical High $1,698.24 | Facility | None | $398.11 | $630.96 | $1,698.24 |
Medica Setting Professional Modifier None Typical Low $389.05 Median $1,096.48 Typical High $3,235.94 | Professional | None | $389.05 | $1,096.48 | $3,235.94 |
Midlands Setting Professional Modifier None Typical Low $660.69 Median $660.69 Typical High $1,023.29 | Professional | None | $660.69 | $660.69 | $1,023.29 |
Midlands Setting Facility Modifier None Typical Low $346.74 Median $398.11 Typical High $457.09 | Facility | None | $346.74 | $398.11 | $457.09 |
Midlands Setting Professional Modifier None Typical Low $588.84 Median $645.65 Typical High $1,000.00 | Professional | None | $588.84 | $645.65 | $1,000.00 |
Sanford Health Plan Setting Professional Modifier None Typical Low $380.19 Median $562.34 Typical High $794.33 | Professional | None | $380.19 | $562.34 | $794.33 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $1,513.56 Typical High $1,819.70 | Facility | None | $1,513.56 | $1,513.56 | $1,819.70 |
United Setting Professional Modifier None Typical Low $338.84 Median $758.58 Typical High $1,230.27 | Professional | None | $338.84 | $758.58 | $1,230.27 |
Wellmark Setting Professional Modifier None Typical Low $588.84 Median $691.83 Typical High $1,096.48 | Professional | None | $588.84 | $691.83 | $1,096.48 |
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 $123.03 Median $186.21 Typical High $218.78 | Professional | 52 · Reduced service | $123.03 | $186.21 | $218.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $48.98 Median $74.13 Typical High $87.10 | Professional | 53 · Discontinued | $48.98 | $74.13 | $87.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $181.97 Median $281.84 Typical High $331.13 | Professional | 54 · Surgery only | $181.97 | $281.84 | $331.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $37.15 Median $56.23 Typical High $66.07 | Professional | 55 · Aftercare only | $37.15 | $56.23 | $66.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $24.55 Median $37.15 Typical High $43.65 | Professional | 56 · Pre-op care only | $24.55 | $37.15 | $43.65 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $169.82 Median $263.03 Typical High $309.03 | Professional | 78 · Unplanned return to OR | $169.82 | $263.03 | $309.03 |
Where South Dakota sits
The same service costs 4.7 times more in Alaska than in Utah. 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
$692
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.