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 $346.74 Median $512.86 Typical High $4,365.16 | Facility | None | $346.74 | $512.86 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $309.03 Median $478.63 Typical High $524.81 | Professional | None | $309.03 | $478.63 | $524.81 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $1,071.52 Typical High $1,737.80 | Facility | None | $812.83 | $1,071.52 | $1,737.80 |
Cigna Setting Professional Modifier None Typical Low $676.08 Median $954.99 Typical High $1,380.38 | Professional | None | $676.08 | $954.99 | $1,380.38 |
Medica Setting Facility Modifier None Typical Low $524.81 Median $758.58 Typical High $1,202.26 | Facility | None | $524.81 | $758.58 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $549.54 Median $1,122.02 Typical High $4,073.80 | Professional | None | $549.54 | $1,122.02 | $4,073.80 |
Midlands Setting Professional Modifier None Typical Low $794.33 Median $912.01 Typical High $1,122.02 | Professional | None | $794.33 | $912.01 | $1,122.02 |
Midlands Setting Facility Modifier None Typical Low $645.65 Median $1,071.52 Typical High $1,995.26 | Facility | None | $645.65 | $1,071.52 | $1,995.26 |
Midlands Setting Professional Modifier None Typical Low $724.44 Median $724.44 Typical High $1,047.13 | Professional | None | $724.44 | $724.44 | $1,047.13 |
Sanford Health Plan Setting Professional Modifier None Typical Low $501.19 Median $691.83 Typical High $1,000.00 | Professional | None | $501.19 | $691.83 | $1,000.00 |
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 $416.87 Median $794.33 Typical High $1,445.44 | Professional | None | $416.87 | $794.33 | $1,445.44 |
Wellmark Setting Professional Modifier None Typical Low $707.95 Median $812.83 Typical High $1,380.38 | Professional | None | $707.95 | $812.83 | $1,380.38 |
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 $154.88 Median $239.88 Typical High $263.03 | Professional | 52 · Reduced service | $154.88 | $239.88 | $263.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $61.66 Median $95.50 Typical High $104.71 | Professional | 53 · Discontinued | $61.66 | $95.50 | $104.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $229.09 Median $354.81 Typical High $398.11 | Professional | 54 · Surgery only | $229.09 | $354.81 | $398.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $45.71 Median $70.79 Typical High $79.43 | Professional | 55 · Aftercare only | $45.71 | $70.79 | $79.43 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $30.90 Median $47.86 Typical High $52.48 | Professional | 56 · Pre-op care only | $30.90 | $47.86 | $52.48 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $213.80 Median $331.13 Typical High $371.54 | Professional | 78 · Unplanned return to OR | $213.80 | $331.13 | $371.54 |
Where South Dakota sits
The same service costs 3.7 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
$832
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.