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 $346.74 Typical High $4,365.16 | Facility | None | $199.53 | $346.74 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $309.03 Typical High $346.74 | Professional | None | $173.78 | $309.03 | $346.74 |
Cigna Setting Facility Modifier None Typical Low $257.04 Median $389.05 Typical High $660.69 | Facility | None | $257.04 | $389.05 | $660.69 |
Cigna Setting Professional Modifier None Typical Low $380.19 Median $588.84 Typical High $912.01 | Professional | None | $380.19 | $588.84 | $912.01 |
Medica Setting Facility Modifier None Typical Low $263.03 Median $524.81 Typical High $1,202.26 | Facility | None | $263.03 | $524.81 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $331.13 Median $676.08 Typical High $2,630.27 | Professional | None | $331.13 | $676.08 | $2,630.27 |
Midlands Setting Professional Modifier None Typical Low $407.38 Median $501.19 Typical High $645.65 | Professional | None | $407.38 | $501.19 | $645.65 |
Midlands Setting Facility Modifier None Typical Low $257.04 Median $338.84 Typical High $467.74 | Facility | None | $257.04 | $338.84 | $467.74 |
Midlands Setting Professional Modifier None Typical Low $371.54 Median $371.54 Typical High $602.56 | Professional | None | $371.54 | $371.54 | $602.56 |
Sanford Health Plan Setting Professional Modifier None Typical Low $302.00 Median $398.11 Typical High $660.69 | Professional | None | $302.00 | $398.11 | $660.69 |
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 $223.87 Median $512.86 Typical High $977.24 | Professional | None | $223.87 | $512.86 | $977.24 |
Wellmark Setting Professional Modifier None Typical Low $416.87 Median $478.63 Typical High $977.24 | Professional | None | $416.87 | $478.63 | $977.24 |
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 $154.88 Typical High $173.78 | Professional | 52 · Reduced service | $85.11 | $154.88 | $173.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $61.66 Typical High $69.18 | Professional | 53 · Discontinued | $34.67 | $61.66 | $69.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $229.09 Typical High $257.04 | Professional | 54 · Surgery only | $128.82 | $229.09 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $46.77 Typical High $51.29 | Professional | 55 · Aftercare only | $25.70 | $46.77 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $30.90 Typical High $34.67 | Professional | 56 · Pre-op care only | $17.38 | $30.90 | $34.67 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $213.80 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $120.23 | $213.80 | $239.88 |
Where South Dakota sits
The same service costs 3.5 times more in Alaska 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· 7th of 51
$513
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.