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 $239.88 Median $239.88 Typical High $4,365.16 | Facility | None | $239.88 | $239.88 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $213.80 Median $213.80 Typical High $416.87 | Professional | None | $213.80 | $213.80 | $416.87 |
Cigna Setting Facility Modifier None Typical Low $363.08 Median $1,445.44 Typical High $1,737.80 | Facility | None | $363.08 | $1,445.44 | $1,737.80 |
Cigna Setting Professional Modifier None Typical Low $416.87 Median $549.54 Typical High $724.44 | Professional | None | $416.87 | $549.54 | $724.44 |
Medica Setting Facility Modifier None Typical Low $323.59 Median $588.84 Typical High $1,819.70 | Facility | None | $323.59 | $588.84 | $1,819.70 |
Medica Setting Professional Modifier None Typical Low $263.03 Median $549.54 Typical High $1,862.09 | Professional | None | $263.03 | $549.54 | $1,862.09 |
Midlands Setting Professional Modifier None Typical Low $549.54 Median $549.54 Typical High $562.34 | Professional | None | $549.54 | $549.54 | $562.34 |
Midlands Setting Facility Modifier None Typical Low $1,288.25 Median $1,479.11 Typical High $1,995.26 | Facility | None | $1,288.25 | $1,479.11 | $1,995.26 |
Midlands Setting Professional Modifier None Typical Low $501.19 Median $501.19 Typical High $501.19 | Professional | None | $501.19 | $501.19 | $501.19 |
Sanford Health Plan Setting Professional Modifier None Typical Low $295.12 Median $354.81 Typical High $489.78 | Professional | None | $295.12 | $354.81 | $489.78 |
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 $234.42 Median $478.63 Typical High $660.69 | Professional | None | $234.42 | $478.63 | $660.69 |
Wellmark Setting Professional Modifier None Typical Low $489.78 Median $562.34 Typical High $562.34 | Professional | None | $489.78 | $562.34 | $562.34 |
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 $107.15 Median $107.15 Typical High $120.23 | Professional | 52 · Reduced service | $107.15 | $107.15 | $120.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $42.66 Median $42.66 Typical High $47.86 | Professional | 53 · Discontinued | $42.66 | $42.66 | $47.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $158.49 Typical High $181.97 | Professional | 54 · Surgery only | $158.49 | $158.49 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $31.62 Typical High $36.31 | Professional | 55 · Aftercare only | $31.62 | $31.62 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.38 Median $21.38 Typical High $23.99 | Professional | 56 · Pre-op care only | $21.38 | $21.38 | $23.99 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $147.91 Median $147.91 Typical High $169.82 | Professional | 78 · Unplanned return to OR | $147.91 | $147.91 | $169.82 |
Where South Dakota sits
The same service costs 6.0 times more in Alaska than in Utah. 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
$550
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.