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 $109.65 Median $213.80 Typical High $4,365.16 | Facility | None | $109.65 | $213.80 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $95.50 Median $181.97 Typical High $257.04 | Professional | None | $95.50 | $181.97 | $257.04 |
Cigna Setting Facility Modifier None Typical Low $316.23 Median $457.09 Typical High $891.25 | Facility | None | $316.23 | $457.09 | $891.25 |
Cigna Setting Professional Modifier None Typical Low $223.87 Median $323.59 Typical High $575.44 | Professional | None | $223.87 | $323.59 | $575.44 |
Medica Setting Facility Modifier None Typical Low $162.18 Median $323.59 Typical High $1,202.26 | Facility | None | $162.18 | $323.59 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $223.87 Median $467.74 Typical High $1,621.81 | Professional | None | $223.87 | $467.74 | $1,621.81 |
Midlands Setting Professional Modifier None Typical Low $251.19 Median $281.84 Typical High $467.74 | Professional | None | $251.19 | $281.84 | $467.74 |
Midlands Setting Facility Modifier None Typical Low $457.09 Median $645.65 Typical High $891.25 | Facility | None | $457.09 | $645.65 | $891.25 |
Midlands Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $426.58 | Professional | None | $223.87 | $223.87 | $426.58 |
Sanford Health Plan Setting Professional Modifier None Typical Low $151.36 Median $251.19 Typical High $389.05 | Professional | None | $151.36 | $251.19 | $389.05 |
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 $128.82 Median $288.40 Typical High $588.84 | Professional | None | $128.82 | $288.40 | $588.84 |
Wellmark Setting Professional Modifier None Typical Low $229.09 Median $263.03 Typical High $537.03 | Professional | None | $229.09 | $263.03 | $537.03 |
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 $47.86 Median $91.20 Typical High $104.71 | Professional | 52 · Reduced service | $47.86 | $91.20 | $104.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $37.15 Typical High $41.69 | Professional | 53 · Discontinued | $19.05 | $37.15 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $72.44 Median $138.04 Typical High $154.88 | Professional | 54 · Surgery only | $72.44 | $138.04 | $154.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.45 Median $27.54 Typical High $30.90 | Professional | 55 · Aftercare only | $14.45 | $27.54 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $18.20 Typical High $20.89 | Professional | 56 · Pre-op care only | $9.55 | $18.20 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $67.61 Median $128.82 Typical High $144.54 | Professional | 78 · Unplanned return to OR | $67.61 | $128.82 | $144.54 |
Where South Dakota sits
The same service costs 3.3 times more in Alaska than in Washington, DC. 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
$295
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.