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 $120.23 Median $190.55 Typical High $4,365.16 | Facility | None | $120.23 | $190.55 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $158.49 Typical High $229.09 | Professional | None | $104.71 | $158.49 | $229.09 |
Cigna Setting Facility Modifier None Typical Low $117.49 Median $194.98 Typical High $338.84 | Facility | None | $117.49 | $194.98 | $338.84 |
Cigna Setting Professional Modifier None Typical Low $275.42 Median $371.54 Typical High $549.54 | Professional | None | $275.42 | $371.54 | $549.54 |
Medica Setting Facility Modifier None Typical Low $165.96 Median $263.03 Typical High $549.54 | Facility | None | $165.96 | $263.03 | $549.54 |
Medica Setting Professional Modifier None Typical Low $169.82 Median $501.19 Typical High $1,380.38 | Professional | None | $169.82 | $501.19 | $1,380.38 |
Midlands Setting Professional Modifier None Typical Low $275.42 Median $281.84 Typical High $426.58 | Professional | None | $275.42 | $281.84 | $426.58 |
Midlands Setting Facility Modifier None Typical Low $117.49 Median $194.98 Typical High $218.78 | Facility | None | $117.49 | $194.98 | $218.78 |
Midlands Setting Professional Modifier None Typical Low $251.19 Median $251.19 Typical High $389.05 | Professional | None | $251.19 | $251.19 | $389.05 |
Sanford Health Plan Setting Professional Modifier None Typical Low $173.78 Median $263.03 Typical High $354.81 | Professional | None | $173.78 | $263.03 | $354.81 |
United Setting Facility Modifier None Typical Low $446.68 Median $537.03 Typical High $758.58 | Facility | None | $446.68 | $537.03 | $758.58 |
United Setting Professional Modifier None Typical Low $141.25 Median $338.84 Typical High $524.81 | Professional | None | $141.25 | $338.84 | $524.81 |
Wellmark Setting Professional Modifier None Typical Low $234.42 Median $288.40 Typical High $467.74 | Professional | None | $234.42 | $288.40 | $467.74 |
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 $52.48 Median $61.66 Typical High $91.20 | Professional | 52 · Reduced service | $52.48 | $61.66 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $25.12 Typical High $37.15 | Professional | 53 · Discontinued | $20.89 | $25.12 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $93.33 Typical High $138.04 | Professional | 54 · Surgery only | $79.43 | $93.33 | $138.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $18.62 Typical High $27.54 | Professional | 55 · Aftercare only | $15.85 | $18.62 | $27.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $12.30 Typical High $18.62 | Professional | 56 · Pre-op care only | $10.47 | $12.30 | $18.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $87.10 Typical High $128.82 | Professional | 78 · Unplanned return to OR | $74.13 | $87.10 | $128.82 |
Where South Dakota sits
The same service costs 4.1 times more in Alaska than in Kentucky. 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
$295
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.