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 $147.91 Median $5,011.87 Typical High $7,943.28 | Facility | None | $147.91 | $5,011.87 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $147.91 Typical High $223.87 | Professional | None | $89.13 | $147.91 | $223.87 |
Cigna Setting Facility Modifier None Typical Low $107.15 Median $134.90 Typical High $169.82 | Facility | None | $107.15 | $134.90 | $169.82 |
Cigna Setting Professional Modifier None Typical Low $199.53 Median $251.19 Typical High $316.23 | Professional | None | $199.53 | $251.19 | $316.23 |
Hally Health Setting Professional Modifier None Typical Low $81.28 Median $165.96 Typical High $302.00 | Professional | None | $81.28 | $165.96 | $302.00 |
Medica Setting Facility Modifier None Typical Low $141.25 Median $257.04 Typical High $1,288.25 | Facility | None | $141.25 | $257.04 | $1,288.25 |
Medica Setting Professional Modifier None Typical Low $158.49 Median $245.47 Typical High $660.69 | Professional | None | $158.49 | $245.47 | $660.69 |
Midlands Setting Professional Modifier None Typical Low $199.53 Median $251.19 Typical High $316.23 | Professional | None | $199.53 | $251.19 | $316.23 |
Midlands Setting Facility Modifier None Typical Low $102.33 Median $134.90 Typical High $169.82 | Facility | None | $102.33 | $134.90 | $169.82 |
Midlands Setting Professional Modifier None Typical Low $158.49 Median $229.09 Typical High $354.81 | Professional | None | $158.49 | $229.09 | $354.81 |
United Setting Facility Modifier None Typical Low $223.87 Median $707.95 Typical High $1,995.26 | Facility | None | $223.87 | $707.95 | $1,995.26 |
United Setting Professional Modifier None Typical Low $97.72 Median $169.82 Typical High $295.12 | Professional | None | $97.72 | $169.82 | $295.12 |
Wellmark Setting Professional Modifier None Typical Low $165.96 Median $194.98 Typical High $281.84 | Professional | None | $165.96 | $194.98 | $281.84 |
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 $48.98 Median $74.13 Typical High $97.72 | Professional | 52 · Reduced service | $48.98 | $74.13 | $97.72 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $29.51 Typical High $38.90 | Professional | 53 · Discontinued | $19.95 | $29.51 | $38.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $109.65 Typical High $144.54 | Professional | 54 · Surgery only | $74.13 | $109.65 | $144.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $21.88 Typical High $29.51 | Professional | 55 · Aftercare only | $14.79 | $21.88 | $29.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $14.79 Typical High $19.50 | Professional | 56 · Pre-op care only | $10.00 | $14.79 | $19.50 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $102.33 Typical High $134.90 | Professional | 78 · Unplanned return to OR | $69.18 | $102.33 | $134.90 |
Where Iowa sits
The same service costs 3.3 times more in Alaska than in Pennsylvania. 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.
Iowa· 5th of 51
$229
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.