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 $112.20 Median $616.60 Typical High $616.60 | Facility | None | $112.20 | $616.60 | $616.60 |
Aetna Setting Professional Modifier None Typical Low $74.13 Median $100.00 Typical High $144.54 | Professional | None | $74.13 | $100.00 | $144.54 |
Cigna Setting Facility Modifier None Typical Low $81.28 Median $109.65 Typical High $218.78 | Facility | None | $81.28 | $109.65 | $218.78 |
Cigna Setting Professional Modifier None Typical Low $194.98 Median $251.19 Typical High $346.74 | Professional | None | $194.98 | $251.19 | $346.74 |
Medica Setting Facility Modifier None Typical Low $114.82 Median $144.54 Typical High $223.87 | Facility | None | $114.82 | $144.54 | $223.87 |
Medica Setting Professional Modifier None Typical Low $117.49 Median $302.00 Typical High $870.96 | Professional | None | $117.49 | $302.00 | $870.96 |
Midlands Setting Professional Modifier None Typical Low $194.98 Median $199.53 Typical High $251.19 | Professional | None | $194.98 | $199.53 | $251.19 |
Midlands Setting Facility Modifier None Typical Low $81.28 Median $107.15 Typical High $128.82 | Facility | None | $81.28 | $107.15 | $128.82 |
Midlands Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $218.78 | Professional | None | $173.78 | $173.78 | $218.78 |
Sanford Health Plan Setting Professional Modifier None Typical Low $114.82 Median $169.82 Typical High $218.78 | Professional | None | $114.82 | $169.82 | $218.78 |
United Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $223.87 | Facility | None | $125.89 | $125.89 | $223.87 |
United Setting Professional Modifier None Typical Low $97.72 Median $223.87 Typical High $316.23 | Professional | None | $97.72 | $223.87 | $316.23 |
Wellmark Setting Professional Modifier None Typical Low $165.96 Median $204.17 Typical High $295.12 | Professional | None | $165.96 | $204.17 | $295.12 |
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 $37.15 Median $42.66 Typical High $56.23 | Professional | 52 · Reduced service | $37.15 | $42.66 | $56.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.79 Median $16.98 Typical High $22.39 | Professional | 53 · Discontinued | $14.79 | $16.98 | $22.39 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $56.23 Median $63.10 Typical High $83.18 | Professional | 54 · Surgery only | $56.23 | $63.10 | $83.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.22 Median $12.59 Typical High $16.98 | Professional | 55 · Aftercare only | $11.22 | $12.59 | $16.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.41 Median $8.51 Typical High $11.22 | Professional | 56 · Pre-op care only | $7.41 | $8.51 | $11.22 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $52.48 Median $58.88 Typical High $77.62 | Professional | 78 · Unplanned return to OR | $52.48 | $58.88 | $77.62 |
Where South Dakota 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.
South Dakota· 8th of 51
$195
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.