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 $223.87 Median $346.74 Typical High $4,365.16 | Facility | None | $223.87 | $346.74 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $186.21 Median $302.00 Typical High $338.84 | Professional | None | $186.21 | $302.00 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $239.88 Median $346.74 Typical High $645.65 | Facility | None | $239.88 | $346.74 | $645.65 |
Cigna Setting Professional Modifier None Typical Low $407.38 Median $616.60 Typical High $912.01 | Professional | None | $407.38 | $616.60 | $912.01 |
Medica Setting Facility Modifier None Typical Low $316.23 Median $512.86 Typical High $1,202.26 | Facility | None | $316.23 | $512.86 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $338.84 Median $724.44 Typical High $2,630.27 | Professional | None | $338.84 | $724.44 | $2,630.27 |
Midlands Setting Professional Modifier None Typical Low $478.63 Median $562.34 Typical High $724.44 | Professional | None | $478.63 | $562.34 | $724.44 |
Midlands Setting Facility Modifier None Typical Low $239.88 Median $316.23 Typical High $416.87 | Facility | None | $239.88 | $316.23 | $416.87 |
Midlands Setting Professional Modifier None Typical Low $457.09 Median $457.09 Typical High $645.65 | Professional | None | $457.09 | $457.09 | $645.65 |
Sanford Health Plan Setting Professional Modifier None Typical Low $323.59 Median $436.52 Typical High $660.69 | Professional | None | $323.59 | $436.52 | $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 $257.04 Median $524.81 Typical High $977.24 | Professional | None | $257.04 | $524.81 | $977.24 |
Wellmark Setting Professional Modifier None Typical Low $446.68 Median $512.86 Typical High $977.24 | Professional | None | $446.68 | $512.86 | $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 $93.33 Median $151.36 Typical High $169.82 | Professional | 52 · Reduced service | $93.33 | $151.36 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $60.26 Typical High $67.61 | Professional | 53 · Discontinued | $37.15 | $60.26 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $229.09 Typical High $257.04 | Professional | 54 · Surgery only | $141.25 | $229.09 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $45.71 Typical High $51.29 | Professional | 55 · Aftercare only | $28.18 | $45.71 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $30.20 Typical High $33.88 | Professional | 56 · Pre-op care only | $18.62 | $30.20 | $33.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $131.83 Median $213.80 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $131.83 | $213.80 | $239.88 |
Where South Dakota sits
The same service costs 3.6 times more in Alaska than in New Jersey. 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.