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 $162.18 Median $234.42 Typical High $4,365.16 | Facility | None | $162.18 | $234.42 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $141.25 Median $204.17 Typical High $281.84 | Professional | None | $141.25 | $204.17 | $281.84 |
Cigna Setting Facility Modifier None Typical Low $190.55 Median $223.87 Typical High $436.52 | Facility | None | $190.55 | $223.87 | $436.52 |
Cigna Setting Professional Modifier None Typical Low $323.59 Median $446.68 Typical High $562.34 | Professional | None | $323.59 | $446.68 | $562.34 |
Medica Setting Facility Modifier None Typical Low $239.88 Median $346.74 Typical High $1,202.26 | Facility | None | $239.88 | $346.74 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $263.03 Median $524.81 Typical High $1,737.80 | Professional | None | $263.03 | $524.81 | $1,737.80 |
Midlands Setting Professional Modifier None Typical Low $380.19 Median $416.87 Typical High $524.81 | Professional | None | $380.19 | $416.87 | $524.81 |
Midlands Setting Facility Modifier None Typical Low $190.55 Median $218.78 Typical High $245.47 | Facility | None | $190.55 | $218.78 | $245.47 |
Midlands Setting Professional Modifier None Typical Low $338.84 Median $338.84 Typical High $478.63 | Professional | None | $338.84 | $338.84 | $478.63 |
Sanford Health Plan Setting Professional Modifier None Typical Low $229.09 Median $316.23 Typical High $436.52 | Professional | None | $229.09 | $316.23 | $436.52 |
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 $194.98 Median $363.08 Typical High $645.65 | Professional | None | $194.98 | $363.08 | $645.65 |
Wellmark Setting Professional Modifier None Typical Low $331.13 Median $380.19 Typical High $602.56 | Professional | None | $331.13 | $380.19 | $602.56 |
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 $70.79 Median $102.33 Typical High $112.20 | Professional | 52 · Reduced service | $70.79 | $102.33 | $112.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $40.74 Typical High $45.71 | Professional | 53 · Discontinued | $28.18 | $40.74 | $45.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $151.36 Typical High $169.82 | Professional | 54 · Surgery only | $107.15 | $151.36 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $30.90 Typical High $33.88 | Professional | 55 · Aftercare only | $21.38 | $30.90 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $20.42 Typical High $22.91 | Professional | 56 · Pre-op care only | $14.13 | $20.42 | $22.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $141.25 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $100.00 | $141.25 | $158.49 |
Where South Dakota sits
The same service costs 3.8 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· 6th of 51
$380
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.