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 $616.60 Median $616.60 Typical High $4,365.16 | Facility | None | $616.60 | $616.60 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $524.81 Median $524.81 Typical High $616.60 | Professional | None | $524.81 | $524.81 | $616.60 |
Cigna Setting Facility Modifier None Typical Low $891.25 Median $1,445.44 Typical High $3,019.95 | Facility | None | $891.25 | $1,445.44 | $3,019.95 |
Cigna Setting Professional Modifier None Typical Low $1,000.00 Median $1,412.54 Typical High $1,778.28 | Professional | None | $1,000.00 | $1,412.54 | $1,778.28 |
Medica Setting Facility Modifier None Typical Low $758.58 Median $1,445.44 Typical High $3,311.31 | Facility | None | $758.58 | $1,445.44 | $3,311.31 |
Medica Setting Professional Modifier None Typical Low $707.95 Median $1,412.54 Typical High $5,888.44 | Professional | None | $707.95 | $1,412.54 | $5,888.44 |
Midlands Setting Professional Modifier None Typical Low $1,348.96 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,348.96 | $1,412.54 | $1,412.54 |
Midlands Setting Facility Modifier None Typical Low $1,288.25 Median $1,737.80 Typical High $3,019.95 | Facility | None | $1,288.25 | $1,737.80 | $3,019.95 |
Midlands Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,258.93 | Professional | None | $1,258.93 | $1,258.93 | $1,258.93 |
Sanford Health Plan Setting Professional Modifier None Typical Low $724.44 Median $912.01 Typical High $1,174.90 | Professional | None | $724.44 | $912.01 | $1,174.90 |
United Setting Facility Modifier None Typical Low $2,818.38 Median $2,818.38 Typical High $3,311.31 | Facility | None | $2,818.38 | $2,818.38 | $3,311.31 |
United Setting Professional Modifier None Typical Low $602.56 Median $1,258.93 Typical High $1,698.24 | Professional | None | $602.56 | $1,258.93 | $1,698.24 |
Wellmark Setting Professional Modifier None Typical Low $1,174.90 Median $1,380.38 Typical High $1,380.38 | Professional | None | $1,174.90 | $1,380.38 | $1,380.38 |
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 $263.03 Median $263.03 Typical High $309.03 | Professional | 52 · Reduced service | $263.03 | $263.03 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $104.71 Median $104.71 Typical High $123.03 | Professional | 53 · Discontinued | $104.71 | $104.71 | $123.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $389.05 Median $389.05 Typical High $457.09 | Professional | 54 · Surgery only | $389.05 | $389.05 | $457.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $77.62 Median $77.62 Typical High $91.20 | Professional | 55 · Aftercare only | $77.62 | $77.62 | $91.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $52.48 Median $52.48 Typical High $61.66 | Professional | 56 · Pre-op care only | $52.48 | $52.48 | $61.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $363.08 Median $363.08 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $363.08 | $363.08 | $426.58 |
Where South Dakota sits
The same service costs 6.5 times more in Alaska 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· 5th of 51
$1,380
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.