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 $489.78 Median $3,388.44 Typical High $6,760.83 | Facility | None | $489.78 | $3,388.44 | $6,760.83 |
Aetna Setting Professional Modifier None Typical Low $213.80 Median $338.84 Typical High $489.78 | Professional | None | $213.80 | $338.84 | $489.78 |
Cigna Setting Facility Modifier None Typical Low $416.87 Median $512.86 Typical High $691.83 | Facility | None | $416.87 | $512.86 | $691.83 |
Cigna Setting Professional Modifier None Typical Low $457.09 Median $602.56 Typical High $794.33 | Professional | None | $457.09 | $602.56 | $794.33 |
Hally Health Setting Professional Modifier None Typical Low $186.21 Median $407.38 Typical High $616.60 | Professional | None | $186.21 | $407.38 | $616.60 |
Medica Setting Facility Modifier None Typical Low $331.13 Median $630.96 Typical High $1,621.81 | Facility | None | $331.13 | $630.96 | $1,621.81 |
Medica Setting Professional Modifier None Typical Low $331.13 Median $630.96 Typical High $1,698.24 | Professional | None | $331.13 | $630.96 | $1,698.24 |
Midlands Setting Professional Modifier None Typical Low $457.09 Median $660.69 Typical High $794.33 | Professional | None | $457.09 | $660.69 | $794.33 |
Midlands Setting Facility Modifier None Typical Low $380.19 Median $524.81 Typical High $691.83 | Facility | None | $380.19 | $524.81 | $691.83 |
Midlands Setting Professional Modifier None Typical Low $436.52 Median $602.56 Typical High $891.25 | Professional | None | $436.52 | $602.56 | $891.25 |
United Setting Facility Modifier None Typical Low $223.87 Median $1,000.00 Typical High $1,995.26 | Facility | None | $223.87 | $1,000.00 | $1,995.26 |
United Setting Professional Modifier None Typical Low $239.88 Median $457.09 Typical High $776.25 | Professional | None | $239.88 | $457.09 | $776.25 |
Wellmark Setting Professional Modifier None Typical Low $416.87 Median $467.74 Typical High $758.58 | Professional | None | $416.87 | $467.74 | $758.58 |
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 $107.15 Median $169.82 Typical High $245.47 | Professional | 52 · Reduced service | $107.15 | $169.82 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $42.66 Median $69.18 Typical High $97.72 | Professional | 53 · Discontinued | $42.66 | $69.18 | $97.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $257.04 Typical High $371.54 | Professional | 54 · Surgery only | $158.49 | $257.04 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $51.29 Typical High $74.13 | Professional | 55 · Aftercare only | $31.62 | $51.29 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.38 Median $33.88 Typical High $48.98 | Professional | 56 · Pre-op care only | $21.38 | $33.88 | $48.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $147.91 Median $239.88 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $147.91 | $239.88 | $346.74 |
Where Iowa sits
The same service costs 3.7 times more in Wisconsin 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.
Iowa· 5th of 51
$550
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.