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 $151.36 Typical High $4,365.16 | Facility | None | $112.20 | $151.36 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $95.50 Median $134.90 Typical High $190.55 | Professional | None | $95.50 | $134.90 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $70.79 Median $123.03 Typical High $302.00 | Facility | None | $70.79 | $123.03 | $302.00 |
Cigna Setting Professional Modifier None Typical Low $257.04 Median $323.59 Typical High $478.63 | Professional | None | $257.04 | $323.59 | $478.63 |
Medica Setting Facility Modifier None Typical Low $162.18 Median $245.47 Typical High $1,698.24 | Facility | None | $162.18 | $245.47 | $1,698.24 |
Medica Setting Professional Modifier None Typical Low $131.83 Median $398.11 Typical High $1,258.93 | Professional | None | $131.83 | $398.11 | $1,258.93 |
Midlands Setting Professional Modifier None Typical Low $263.03 Median $269.15 Typical High $316.23 | Professional | None | $263.03 | $269.15 | $316.23 |
Midlands Setting Facility Modifier None Typical Low $70.79 Median $95.50 Typical High $147.91 | Facility | None | $70.79 | $95.50 | $147.91 |
Midlands Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $309.03 | Professional | None | $239.88 | $239.88 | $309.03 |
Sanford Health Plan Setting Professional Modifier None Typical Low $151.36 Median $218.78 Typical High $302.00 | Professional | None | $151.36 | $218.78 | $302.00 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $1,513.56 Typical High $1,819.70 | Facility | None | $1,513.56 | $1,513.56 | $1,819.70 |
United Setting Professional Modifier None Typical Low $131.83 Median $302.00 Typical High $416.87 | Professional | None | $131.83 | $302.00 | $416.87 |
Wellmark Setting Professional Modifier None Typical Low $204.17 Median $251.19 Typical High $398.11 | Professional | None | $204.17 | $251.19 | $398.11 |
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 $47.86 Median $56.23 Typical High $77.62 | Professional | 52 · Reduced service | $47.86 | $56.23 | $77.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $22.39 Typical High $30.90 | Professional | 53 · Discontinued | $19.05 | $22.39 | $30.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $70.79 Median $85.11 Typical High $114.82 | Professional | 54 · Surgery only | $70.79 | $85.11 | $114.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.13 Median $16.98 Typical High $22.91 | Professional | 55 · Aftercare only | $14.13 | $16.98 | $22.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $11.22 Typical High $15.49 | Professional | 56 · Pre-op care only | $9.55 | $11.22 | $15.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $66.07 Median $79.43 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $66.07 | $79.43 | $107.15 |
Where South Dakota sits
The same service costs 3.6 times more in Wisconsin than in Texas. 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
$263
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.