How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $436.52 Median $436.52 Typical High $4,365.16 | Facility | None | $436.52 | $436.52 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $407.38 Median $407.38 Typical High $446.68 | Professional | None | $407.38 | $407.38 | $446.68 |
Cigna Setting Facility Modifier None Typical Low $758.58 Median $758.58 Typical High $933.25 | Facility | None | $758.58 | $758.58 | $933.25 |
Cigna Setting Professional Modifier None Typical Low $851.14 Median $1,230.27 Typical High $1,513.56 | Professional | None | $851.14 | $1,230.27 | $1,513.56 |
Medica Setting Facility Modifier None Typical Low $602.56 Median $758.58 Typical High $1,202.26 | Facility | None | $602.56 | $758.58 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $416.87 Median $912.01 Typical High $16,595.87 | Professional | None | $416.87 | $912.01 | $16,595.87 |
Midlands Setting Professional Modifier None Typical Low $1,047.13 Median $1,348.96 Typical High $1,348.96 | Professional | None | $1,047.13 | $1,348.96 | $1,348.96 |
Midlands Setting Professional Modifier None Typical Low $933.25 Median $933.25 Typical High $933.25 | Professional | None | $933.25 | $933.25 | $933.25 |
United Setting Facility Modifier None Typical Low $758.58 Median $758.58 Typical High $1,202.26 | Facility | None | $758.58 | $758.58 | $1,202.26 |
United Setting Professional Modifier None Typical Low $426.58 Median $724.44 Typical High $1,000.00 | Professional | None | $426.58 | $724.44 | $1,000.00 |
Wellmark Setting Professional Modifier None Typical Low $4,786.30 Median $5,495.41 Typical High $5,495.41 | Professional | None | $4,786.30 | $5,495.41 | $5,495.41 |
4 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 54 · Surgery only Typical Low $302.00 Median $302.00 Typical High $338.84 | Professional | 54 · Surgery only | $302.00 | $302.00 | $338.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $60.26 Typical High $67.61 | Professional | 55 · Aftercare only | $60.26 | $60.26 | $67.61 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $40.74 Typical High $44.67 | Professional | 56 · Pre-op care only | $40.74 | $40.74 | $44.67 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $281.84 Typical High $316.23 | Professional | 78 · Unplanned return to OR | $281.84 | $281.84 | $316.23 |
Where South Dakota sits
The same service costs 11.7 times more in New York than in North Carolina. 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
$1,096
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.