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 $125.89 Median $208.93 Typical High $4,365.16 | Facility | None | $125.89 | $208.93 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $177.83 Typical High $239.88 | Professional | None | $109.65 | $177.83 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $208.93 Median $245.47 Typical High $389.05 | Facility | None | $208.93 | $245.47 | $389.05 |
Cigna Setting Professional Modifier None Typical Low $288.40 Median $380.19 Typical High $616.60 | Professional | None | $288.40 | $380.19 | $616.60 |
Medica Setting Facility Modifier None Typical Low $186.21 Median $302.00 Typical High $1,202.26 | Facility | None | $186.21 | $302.00 | $1,202.26 |
Medica Setting Professional Modifier None Typical Low $199.53 Median $549.54 Typical High $1,584.89 | Professional | None | $199.53 | $549.54 | $1,584.89 |
Midlands Setting Professional Modifier None Typical Low $288.40 Median $295.12 Typical High $467.74 | Professional | None | $288.40 | $295.12 | $467.74 |
Midlands Setting Facility Modifier None Typical Low $208.93 Median $239.88 Typical High $269.15 | Facility | None | $208.93 | $239.88 | $269.15 |
Midlands Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $416.87 | Professional | None | $257.04 | $257.04 | $416.87 |
Sanford Health Plan Setting Professional Modifier None Typical Low $181.97 Median $288.40 Typical High $407.38 | Professional | None | $181.97 | $288.40 | $407.38 |
United Setting Facility Modifier None Typical Low $758.58 Median $891.25 Typical High $1,698.24 | Facility | None | $758.58 | $891.25 | $1,698.24 |
United Setting Professional Modifier None Typical Low $151.36 Median $346.74 Typical High $575.44 | Professional | None | $151.36 | $346.74 | $575.44 |
Wellmark Setting Professional Modifier None Typical Low $239.88 Median $295.12 Typical High $512.86 | Professional | None | $239.88 | $295.12 | $512.86 |
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 $54.95 Median $64.57 Typical High $104.71 | Professional | 52 · Reduced service | $54.95 | $64.57 | $104.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $25.70 Typical High $41.69 | Professional | 53 · Discontinued | $21.88 | $25.70 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $97.72 Typical High $158.49 | Professional | 54 · Surgery only | $83.18 | $97.72 | $158.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $19.50 Typical High $31.62 | Professional | 55 · Aftercare only | $16.60 | $19.50 | $31.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $12.88 Typical High $20.89 | Professional | 56 · Pre-op care only | $10.96 | $12.88 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $77.62 Median $91.20 Typical High $147.91 | Professional | 78 · Unplanned return to OR | $77.62 | $91.20 | $147.91 |
Where South Dakota sits
The same service costs 3.9 times more in Oklahoma 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· 8th of 51
$324
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.