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 $144.54 Median $239.88 Typical High $4,365.16 | Facility | None | $144.54 | $239.88 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $199.53 Typical High $218.78 | Professional | None | $120.23 | $199.53 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $208.93 Median $245.47 Typical High $416.87 | Facility | None | $208.93 | $245.47 | $416.87 |
Cigna Setting Professional Modifier None Typical Low $288.40 Median $416.87 Typical High $602.56 | Professional | None | $288.40 | $416.87 | $602.56 |
Medica Setting Facility Modifier None Typical Low $190.55 Median $331.13 Typical High $1,202.26 | Facility | None | $190.55 | $331.13 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $275.42 Median $537.03 Typical High $1,698.24 | Professional | None | $275.42 | $537.03 | $1,698.24 |
Midlands Setting Professional Modifier None Typical Low $338.84 Median $354.81 Typical High $537.03 | Professional | None | $338.84 | $354.81 | $537.03 |
Midlands Setting Facility Modifier None Typical Low $208.93 Median $245.47 Typical High $275.42 | Facility | None | $208.93 | $245.47 | $275.42 |
Midlands Setting Professional Modifier None Typical Low $302.00 Median $302.00 Typical High $489.78 | Professional | None | $302.00 | $302.00 | $489.78 |
Sanford Health Plan Setting Professional Modifier None Typical Low $194.98 Median $288.40 Typical High $416.87 | Professional | None | $194.98 | $288.40 | $416.87 |
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 $181.97 Median $363.08 Typical High $660.69 | Professional | None | $181.97 | $363.08 | $660.69 |
Wellmark Setting Professional Modifier None Typical Low $281.84 Median $331.13 Typical High $588.84 | Professional | None | $281.84 | $331.13 | $588.84 |
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 $60.26 Median $97.72 Typical High $109.65 | Professional | 52 · Reduced service | $60.26 | $97.72 | $109.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $39.81 Typical High $43.65 | Professional | 53 · Discontinued | $24.55 | $39.81 | $43.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $147.91 Typical High $162.18 | Professional | 54 · Surgery only | $91.20 | $147.91 | $162.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $29.51 Typical High $32.36 | Professional | 55 · Aftercare only | $18.20 | $29.51 | $32.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $19.95 Typical High $21.88 | Professional | 56 · Pre-op care only | $12.02 | $19.95 | $21.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $138.04 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $85.11 | $138.04 | $151.36 |
Where South Dakota sits
The same service costs 3.5 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
$339
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.