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 $302.00 Typical High $4,365.16 | Facility | None | $223.87 | $302.00 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $263.03 Typical High $380.19 | Professional | None | $194.98 | $263.03 | $380.19 |
Cigna Setting Facility Modifier None Typical Low $446.68 Median $891.25 Typical High $1,659.59 | Facility | None | $446.68 | $891.25 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $426.58 Median $588.84 Typical High $758.58 | Professional | None | $426.58 | $588.84 | $758.58 |
Medica Setting Facility Modifier None Typical Low $302.00 Median $446.68 Typical High $1,202.26 | Facility | None | $302.00 | $446.68 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $346.74 Median $691.83 Typical High $2,290.87 | Professional | None | $346.74 | $691.83 | $2,290.87 |
Midlands Setting Professional Modifier None Typical Low $524.81 Median $575.44 Typical High $691.83 | Professional | None | $524.81 | $575.44 | $691.83 |
Midlands Setting Facility Modifier None Typical Low $891.25 Median $954.99 Typical High $1,659.59 | Facility | None | $891.25 | $954.99 | $1,659.59 |
Midlands Setting Professional Modifier None Typical Low $467.74 Median $467.74 Typical High $616.60 | Professional | None | $467.74 | $467.74 | $616.60 |
Sanford Health Plan Setting Professional Modifier None Typical Low $302.00 Median $426.58 Typical High $575.44 | Professional | None | $302.00 | $426.58 | $575.44 |
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 $263.03 Median $478.63 Typical High $831.76 | Professional | None | $263.03 | $478.63 | $831.76 |
Wellmark Setting Professional Modifier None Typical Low $446.68 Median $512.86 Typical High $776.25 | Professional | None | $446.68 | $512.86 | $776.25 |
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 $97.72 Median $131.83 Typical High $147.91 | Professional | 52 · Reduced service | $97.72 | $131.83 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $52.48 Typical High $58.88 | Professional | 53 · Discontinued | $38.90 | $52.48 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $199.53 Typical High $218.78 | Professional | 54 · Surgery only | $144.54 | $199.53 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $39.81 Typical High $43.65 | Professional | 55 · Aftercare only | $29.51 | $39.81 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $26.30 Typical High $29.51 | Professional | 56 · Pre-op care only | $19.50 | $26.30 | $29.51 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $186.21 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $134.90 | $186.21 | $204.17 |
Where South Dakota sits
The same service costs 4.3 times more in Alaska than in Utah. 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
$525
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.