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 $100.00 Median $151.36 Typical High $4,365.16 | Facility | None | $100.00 | $151.36 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $114.82 Typical High $165.96 | Professional | None | $89.13 | $114.82 | $165.96 |
Cigna Setting Facility Modifier None Typical Low $138.04 Median $162.18 Typical High $281.84 | Facility | None | $138.04 | $162.18 | $281.84 |
Cigna Setting Professional Modifier None Typical Low $223.87 Median $309.03 Typical High $446.68 | Professional | None | $223.87 | $309.03 | $446.68 |
Medica Setting Facility Modifier None Typical Low $138.04 Median $223.87 Typical High $1,202.26 | Facility | None | $138.04 | $223.87 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $134.90 Median $398.11 Typical High $1,122.02 | Professional | None | $134.90 | $398.11 | $1,122.02 |
Midlands Setting Professional Modifier None Typical Low $223.87 Median $234.42 Typical High $338.84 | Professional | None | $223.87 | $234.42 | $338.84 |
Midlands Setting Facility Modifier None Typical Low $138.04 Median $158.49 Typical High $186.21 | Facility | None | $138.04 | $158.49 | $186.21 |
Midlands Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $309.03 | Professional | None | $204.17 | $204.17 | $309.03 |
Sanford Health Plan Setting Professional Modifier None Typical Low $144.54 Median $213.80 Typical High $295.12 | Professional | None | $144.54 | $213.80 | $295.12 |
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 $117.49 Median $275.42 Typical High $416.87 | Professional | None | $117.49 | $275.42 | $416.87 |
Wellmark Setting Professional Modifier None Typical Low $194.98 Median $234.42 Typical High $380.19 | Professional | None | $194.98 | $234.42 | $380.19 |
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 $44.67 Median $57.54 Typical High $83.18 | Professional | 52 · Reduced service | $44.67 | $57.54 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.78 Median $22.91 Typical High $33.88 | Professional | 53 · Discontinued | $17.78 | $22.91 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $85.11 Typical High $125.89 | Professional | 54 · Surgery only | $67.61 | $85.11 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $16.98 Typical High $25.12 | Professional | 55 · Aftercare only | $13.49 | $16.98 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $11.48 Typical High $16.60 | Professional | 56 · Pre-op care only | $8.91 | $11.48 | $16.60 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $79.43 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $63.10 | $79.43 | $117.49 |
Where South Dakota sits
The same service costs 4.4 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· 7th of 51
$245
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.