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 $549.54 Median $549.54 Typical High $4,365.16 | Facility | None | $549.54 | $549.54 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $467.74 Median $467.74 Typical High $549.54 | Professional | None | $467.74 | $467.74 | $549.54 |
Cigna Setting Facility Modifier None Typical Low $794.33 Median $891.25 Typical High $1,000.00 | Facility | None | $794.33 | $891.25 | $1,000.00 |
Cigna Setting Professional Modifier None Typical Low $912.01 Median $1,258.93 Typical High $1,584.89 | Professional | None | $912.01 | $1,258.93 | $1,584.89 |
Medica Setting Facility Modifier None Typical Low $724.44 Median $794.33 Typical High $1,479.11 | Facility | None | $724.44 | $794.33 | $1,479.11 |
Medica Setting Professional Modifier None Typical Low $588.84 Median $1,258.93 Typical High $4,168.69 | Professional | None | $588.84 | $1,258.93 | $4,168.69 |
Midlands Setting Professional Modifier None Typical Low $1,202.26 Median $1,258.93 Typical High $1,258.93 | Professional | None | $1,202.26 | $1,258.93 | $1,258.93 |
Midlands Setting Facility Modifier None Typical Low $891.25 Median $891.25 Typical High $1,071.52 | Facility | None | $891.25 | $891.25 | $1,071.52 |
Midlands Setting Professional Modifier None Typical Low $1,047.13 Median $1,047.13 Typical High $1,047.13 | Professional | None | $1,047.13 | $1,047.13 | $1,047.13 |
Sanford Health Plan Setting Professional Modifier None Typical Low $660.69 Median $851.14 Typical High $1,122.02 | Professional | None | $660.69 | $851.14 | $1,122.02 |
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 $524.81 Median $1,071.52 Typical High $1,513.56 | Professional | None | $524.81 | $1,071.52 | $1,513.56 |
Wellmark Setting Professional Modifier None Typical Low $1,230.27 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,230.27 | $1,412.54 | $1,412.54 |
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 $234.42 Median $234.42 Typical High $275.42 | Professional | 52 · Reduced service | $234.42 | $234.42 | $275.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $93.33 Typical High $109.65 | Professional | 53 · Discontinued | $93.33 | $93.33 | $109.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $354.81 Median $354.81 Typical High $416.87 | Professional | 54 · Surgery only | $354.81 | $354.81 | $416.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $70.79 Typical High $83.18 | Professional | 55 · Aftercare only | $70.79 | $70.79 | $83.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $46.77 Typical High $54.95 | Professional | 56 · Pre-op care only | $46.77 | $46.77 | $54.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $331.13 Median $331.13 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $331.13 | $331.13 | $389.05 |
Where South Dakota sits
The same service costs 5.5 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· 6th of 51
$1,202
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.