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 $229.09 Median $363.08 Typical High $4,365.16 | Facility | None | $229.09 | $363.08 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $257.04 Typical High $363.08 | Professional | None | $173.78 | $257.04 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $380.19 Median $457.09 Typical High $630.96 | Facility | None | $380.19 | $457.09 | $630.96 |
Cigna Setting Professional Modifier None Typical Low $478.63 Median $630.96 Typical High $891.25 | Professional | None | $478.63 | $630.96 | $891.25 |
Medica Setting Facility Modifier None Typical Low $125.89 Median $295.12 Typical High $478.63 | Facility | None | $125.89 | $295.12 | $478.63 |
Medica Setting Professional Modifier None Typical Low $309.03 Median $954.99 Typical High $2,187.76 | Professional | None | $309.03 | $954.99 | $2,187.76 |
Midlands Setting Professional Modifier None Typical Low $524.81 Median $524.81 Typical High $794.33 | Professional | None | $524.81 | $524.81 | $794.33 |
Midlands Setting Facility Modifier None Typical Low $354.81 Median $457.09 Typical High $645.65 | Facility | None | $354.81 | $457.09 | $645.65 |
Midlands Setting Professional Modifier None Typical Low $478.63 Median $478.63 Typical High $741.31 | Professional | None | $478.63 | $478.63 | $741.31 |
Sanford Health Plan Setting Professional Modifier None Typical Low $275.42 Median $426.58 Typical High $575.44 | Professional | None | $275.42 | $426.58 | $575.44 |
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 $275.42 Median $645.65 Typical High $1,000.00 | Professional | None | $275.42 | $645.65 | $1,000.00 |
Wellmark Setting Professional Modifier None Typical Low $426.58 Median $489.78 Typical High $794.33 | Professional | None | $426.58 | $489.78 | $794.33 |
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 $87.10 Median $114.82 Typical High $144.54 | Professional | 52 · Reduced service | $87.10 | $114.82 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $46.77 Typical High $57.54 | Professional | 53 · Discontinued | $34.67 | $46.77 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $173.78 Typical High $218.78 | Professional | 54 · Surgery only | $128.82 | $173.78 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $34.67 Typical High $43.65 | Professional | 55 · Aftercare only | $25.70 | $34.67 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $22.91 Typical High $28.84 | Professional | 56 · Pre-op care only | $17.38 | $22.91 | $28.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $162.18 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $120.23 | $162.18 | $204.17 |
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· 7th of 51
$501
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.