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 $117.49 Median $257.04 Typical High $4,365.16 | Facility | None | $117.49 | $257.04 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $234.42 Typical High $338.84 | Professional | None | $104.71 | $234.42 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $158.49 Median $213.80 Typical High $489.78 | Facility | None | $158.49 | $213.80 | $489.78 |
Cigna Setting Professional Modifier None Typical Low $269.15 Median $363.08 Typical High $794.33 | Professional | None | $269.15 | $363.08 | $794.33 |
Medica Setting Facility Modifier None Typical Low $125.89 Median $177.83 Typical High $389.05 | Facility | None | $125.89 | $177.83 | $389.05 |
Medica Setting Professional Modifier None Typical Low $218.78 Median $676.08 Typical High $1,949.84 | Professional | None | $218.78 | $676.08 | $1,949.84 |
Midlands Setting Professional Modifier None Typical Low $269.15 Median $275.42 Typical High $549.54 | Professional | None | $269.15 | $275.42 | $549.54 |
Midlands Setting Facility Modifier None Typical Low $120.23 Median $173.78 Typical High $213.80 | Facility | None | $120.23 | $173.78 | $213.80 |
Midlands Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $512.86 | Professional | None | $245.47 | $245.47 | $512.86 |
Sanford Health Plan Setting Professional Modifier None Typical Low $169.82 Median $281.84 Typical High $489.78 | Professional | None | $169.82 | $281.84 | $489.78 |
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 $138.04 Median $331.13 Typical High $707.95 | Professional | None | $138.04 | $331.13 | $707.95 |
Wellmark Setting Professional Modifier None Typical Low $218.78 Median $269.15 Typical High $645.65 | Professional | None | $218.78 | $269.15 | $645.65 |
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 $52.48 Median $67.61 Typical High $147.91 | Professional | 52 · Reduced service | $52.48 | $67.61 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $26.92 Typical High $58.88 | Professional | 53 · Discontinued | $20.89 | $26.92 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $100.00 Typical High $218.78 | Professional | 54 · Surgery only | $79.43 | $100.00 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $19.95 Typical High $43.65 | Professional | 55 · Aftercare only | $15.85 | $19.95 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $13.49 Typical High $29.51 | Professional | 56 · Pre-op care only | $10.47 | $13.49 | $29.51 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $93.33 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $74.13 | $93.33 | $204.17 |
Where South Dakota sits
The same service costs 3.6 times more in Wisconsin 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· 8th of 51
$316
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.