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 $199.53 Median $5,011.87 Typical High $7,943.28 | Facility | None | $199.53 | $5,011.87 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $128.82 Median $199.53 Typical High $323.59 | Professional | None | $128.82 | $199.53 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $45.71 Median $45.71 Typical High $48.98 | Facility | None | $45.71 | $45.71 | $48.98 |
Cigna Setting Professional Modifier None Typical Low $269.15 Median $426.58 Typical High $512.86 | Professional | None | $269.15 | $426.58 | $512.86 |
Hally Health Setting Professional Modifier None Typical Low $107.15 Median $269.15 Typical High $407.38 | Professional | None | $107.15 | $269.15 | $407.38 |
Medica Setting Facility Modifier None Typical Low $223.87 Median $588.84 Typical High $3,388.44 | Facility | None | $223.87 | $588.84 | $3,388.44 |
Medica Setting Professional Modifier None Typical Low $229.09 Median $416.87 Typical High $851.14 | Professional | None | $229.09 | $416.87 | $851.14 |
Midlands Setting Professional Modifier None Typical Low $269.15 Median $436.52 Typical High $512.86 | Professional | None | $269.15 | $436.52 | $512.86 |
Midlands Setting Facility Modifier None Typical Low $45.71 Median $48.98 Typical High $53.70 | Facility | None | $45.71 | $48.98 | $53.70 |
Midlands Setting Professional Modifier None Typical Low $263.03 Median $346.74 Typical High $588.84 | Professional | None | $263.03 | $346.74 | $588.84 |
United Setting Facility Modifier None Typical Low $724.44 Median $2,398.83 Typical High $5,495.41 | Facility | None | $724.44 | $2,398.83 | $5,495.41 |
United Setting Professional Modifier None Typical Low $134.90 Median $275.42 Typical High $537.03 | Professional | None | $134.90 | $275.42 | $537.03 |
Wellmark Setting Professional Modifier None Typical Low $257.04 Median $281.84 Typical High $512.86 | Professional | None | $257.04 | $281.84 | $512.86 |
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 $64.57 Median $100.00 Typical High $162.18 | Professional | 52 · Reduced service | $64.57 | $100.00 | $162.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $39.81 Typical High $66.07 | Professional | 53 · Discontinued | $25.70 | $39.81 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $147.91 Typical High $245.47 | Professional | 54 · Surgery only | $95.50 | $147.91 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $30.20 Typical High $48.98 | Professional | 55 · Aftercare only | $19.05 | $30.20 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $19.95 Typical High $32.36 | Professional | 56 · Pre-op care only | $12.88 | $19.95 | $32.36 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $89.13 Median $138.04 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $89.13 | $138.04 | $229.09 |
Where Iowa sits
The same service costs 3.8 times more in Wisconsin than in Hawaii. 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
$355
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.