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 $125.89 Median $213.80 Typical High $4,365.16 | Facility | None | $125.89 | $213.80 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $107.15 Median $186.21 Typical High $263.03 | Professional | None | $107.15 | $186.21 | $263.03 |
Cigna Setting Facility Modifier None Typical Low $204.17 Median $251.19 Typical High $407.38 | Facility | None | $204.17 | $251.19 | $407.38 |
Cigna Setting Professional Modifier None Typical Low $288.40 Median $363.08 Typical High $645.65 | Professional | None | $288.40 | $363.08 | $645.65 |
Medica Setting Facility Modifier None Typical Low $181.97 Median $323.59 Typical High $1,202.26 | Facility | None | $181.97 | $323.59 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $186.21 Median $575.44 Typical High $1,621.81 | Professional | None | $186.21 | $575.44 | $1,621.81 |
Midlands Setting Professional Modifier None Typical Low $288.40 Median $288.40 Typical High $478.63 | Professional | None | $288.40 | $288.40 | $478.63 |
Midlands Setting Facility Modifier None Typical Low $204.17 Median $239.88 Typical High $269.15 | Facility | None | $204.17 | $239.88 | $269.15 |
Midlands Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $436.52 | Professional | None | $257.04 | $257.04 | $436.52 |
Sanford Health Plan Setting Professional Modifier None Typical Low $169.82 Median $275.42 Typical High $416.87 | Professional | None | $169.82 | $275.42 | $416.87 |
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 $154.88 Median $346.74 Typical High $602.56 | Professional | None | $154.88 | $346.74 | $602.56 |
Wellmark Setting Professional Modifier None Typical Low $251.19 Median $295.12 Typical High $549.54 | Professional | None | $251.19 | $295.12 | $549.54 |
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 $53.70 Median $63.10 Typical High $104.71 | Professional | 52 · Reduced service | $53.70 | $63.10 | $104.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $25.12 Typical High $41.69 | Professional | 53 · Discontinued | $21.38 | $25.12 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $93.33 Typical High $158.49 | Professional | 54 · Surgery only | $79.43 | $93.33 | $158.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $18.62 Typical High $31.62 | Professional | 55 · Aftercare only | $15.85 | $18.62 | $31.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.72 Median $12.59 Typical High $20.89 | Professional | 56 · Pre-op care only | $10.72 | $12.59 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $87.10 Typical High $147.91 | Professional | 78 · Unplanned return to OR | $74.13 | $87.10 | $147.91 |
Where South Dakota sits
The same service costs 3.8 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
$309
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.