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 $213.80 Median $302.00 Typical High $4,365.16 | Facility | None | $213.80 | $302.00 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $213.80 Typical High $281.84 | Professional | None | $169.82 | $213.80 | $281.84 |
Cigna Setting Facility Modifier None Typical Low $269.15 Median $371.54 Typical High $537.03 | Facility | None | $269.15 | $371.54 | $537.03 |
Cigna Setting Professional Modifier None Typical Low $478.63 Median $588.84 Typical High $851.14 | Professional | None | $478.63 | $588.84 | $851.14 |
Medica Setting Facility Modifier None Typical Low $125.89 Median $288.40 Typical High $467.74 | Facility | None | $125.89 | $288.40 | $467.74 |
Medica Setting Professional Modifier None Typical Low $302.00 Median $812.83 Typical High $2,137.96 | Professional | None | $302.00 | $812.83 | $2,137.96 |
Midlands Setting Professional Modifier None Typical Low $512.86 Median $512.86 Typical High $707.95 | Professional | None | $512.86 | $512.86 | $707.95 |
Midlands Setting Facility Modifier None Typical Low $257.04 Median $309.03 Typical High $457.09 | Facility | None | $257.04 | $309.03 | $457.09 |
Midlands Setting Professional Modifier None Typical Low $436.52 Median $436.52 Typical High $616.60 | Professional | None | $436.52 | $436.52 | $616.60 |
Sanford Health Plan Setting Professional Modifier None Typical Low $295.12 Median $407.38 Typical High $562.34 | Professional | None | $295.12 | $407.38 | $562.34 |
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 $263.03 Median $588.84 Typical High $851.14 | Professional | None | $263.03 | $588.84 | $851.14 |
Wellmark Setting Professional Modifier None Typical Low $407.38 Median $467.74 Typical High $741.31 | Professional | None | $407.38 | $467.74 | $741.31 |
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 $85.11 Median $107.15 Typical High $141.25 | Professional | 52 · Reduced service | $85.11 | $107.15 | $141.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $42.66 Typical High $56.23 | Professional | 53 · Discontinued | $33.88 | $42.66 | $56.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $158.49 Typical High $208.93 | Professional | 54 · Surgery only | $128.82 | $158.49 | $208.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $31.62 Typical High $41.69 | Professional | 55 · Aftercare only | $25.70 | $31.62 | $41.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $21.38 Typical High $28.18 | Professional | 56 · Pre-op care only | $16.98 | $21.38 | $28.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $147.91 Typical High $194.98 | Professional | 78 · Unplanned return to OR | $120.23 | $147.91 | $194.98 |
Where South Dakota sits
The same service costs 3.7 times more in Wisconsin than in Texas. 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
$479
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.