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 $107.15 Median $147.91 Typical High $4,365.16 | Facility | None | $107.15 | $147.91 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $95.50 Median $125.89 Typical High $181.97 | Professional | None | $95.50 | $125.89 | $181.97 |
Cigna Setting Facility Modifier None Typical Low $128.82 Median $147.91 Typical High $269.15 | Facility | None | $128.82 | $147.91 | $269.15 |
Cigna Setting Professional Modifier None Typical Low $213.80 Median $309.03 Typical High $407.38 | Professional | None | $213.80 | $309.03 | $407.38 |
Medica Setting Facility Modifier None Typical Low $162.18 Median $213.80 Typical High $1,202.26 | Facility | None | $162.18 | $213.80 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $165.96 Median $338.84 Typical High $1,096.48 | Professional | None | $165.96 | $338.84 | $1,096.48 |
Midlands Setting Professional Modifier None Typical Low $251.19 Median $281.84 Typical High $338.84 | Professional | None | $251.19 | $281.84 | $338.84 |
Midlands Setting Facility Modifier None Typical Low $128.82 Median $141.25 Typical High $165.96 | Facility | None | $128.82 | $141.25 | $165.96 |
Midlands Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $302.00 | Professional | None | $223.87 | $223.87 | $302.00 |
Sanford Health Plan Setting Professional Modifier None Typical Low $144.54 Median $204.17 Typical High $281.84 | Professional | None | $144.54 | $204.17 | $281.84 |
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 $239.88 Typical High $416.87 | Professional | None | $128.82 | $239.88 | $416.87 |
Wellmark Setting Professional Modifier None Typical Low $223.87 Median $257.04 Typical High $380.19 | Professional | None | $223.87 | $257.04 | $380.19 |
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 $63.10 Typical High $70.79 | Professional | 52 · Reduced service | $47.86 | $63.10 | $70.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $25.70 Typical High $28.18 | Professional | 53 · Discontinued | $19.05 | $25.70 | $28.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $70.79 Median $95.50 Typical High $107.15 | Professional | 54 · Surgery only | $70.79 | $95.50 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.45 Median $19.05 Typical High $21.38 | Professional | 55 · Aftercare only | $14.45 | $19.05 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $12.88 Typical High $14.13 | Professional | 56 · Pre-op care only | $9.55 | $12.88 | $14.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $66.07 Median $89.13 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $66.07 | $89.13 | $100.00 |
Where South Dakota sits
The same service costs 4.0 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· 5th of 51
$257
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.