How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $512,861.38 Median $512,861.38 Typical High $602,559.59 | Facility | None | $512,861.38 | $512,861.38 | $602,559.59 |
Aetna Setting Professional Modifier None Typical Low $512,861.38 Median $512,861.38 Typical High $602,559.59 | Professional | None | $512,861.38 | $512,861.38 | $602,559.59 |
Cigna Setting Professional Modifier None Typical Low $478,630.09 Median $478,630.09 Typical High $602,559.59 | Professional | None | $478,630.09 | $478,630.09 | $602,559.59 |
Medica Setting Facility Modifier None Typical Low $660,693.45 Median $776,247.12 Typical High $776,247.12 | Facility | None | $660,693.45 | $776,247.12 | $776,247.12 |
Medica Setting Professional Modifier None Typical Low $512,861.38 Median $1,000,000.00 Typical High $1,000,000.00 | Professional | None | $512,861.38 | $1,000,000.00 | $1,000,000.00 |
Midlands Setting Professional Modifier None Typical Low $512,861.38 Median $512,861.38 Typical High $512,861.38 | Professional | None | $512,861.38 | $512,861.38 | $512,861.38 |
Sanford Health Plan Setting Professional Modifier None Typical Low $562,341.33 Median $562,341.33 Typical High $562,341.33 | Professional | None | $562,341.33 | $562,341.33 | $562,341.33 |
United Setting Professional Modifier None Typical Low $489,778.82 Median $660,693.45 Typical High $741,310.24 | Professional | None | $489,778.82 | $660,693.45 | $741,310.24 |
4 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 $257,039.58 Median $257,039.58 Typical High $301,995.17 | Professional | 52 · Reduced service | $257,039.58 | $257,039.58 | $301,995.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $102,329.30 Median $102,329.30 Typical High $120,226.44 | Professional | 53 · Discontinued | $102,329.30 | $102,329.30 | $120,226.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $75,857.76 Median $75,857.76 Typical High $91,201.08 | Professional | 55 · Aftercare only | $75,857.76 | $75,857.76 | $91,201.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $51,286.14 Median $51,286.14 Typical High $60,255.96 | Professional | 56 · Pre-op care only | $51,286.14 | $51,286.14 | $60,255.96 |
Where South Dakota sits
The same service costs 2.0 times more in Texas than in New Jersey. 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· 46th of 51
$512,861
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.