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 $1,380.38 Median $1,380.38 Typical High $4,365.16 | Facility | None | $1,380.38 | $1,380.38 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $1,122.02 Median $1,122.02 Typical High $1,380.38 | Professional | None | $1,122.02 | $1,122.02 | $1,380.38 |
Cigna Setting Facility Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $2,398.83 | Facility | None | $1,905.46 | $1,905.46 | $2,398.83 |
Cigna Setting Professional Modifier None Typical Low $2,187.76 Median $3,090.30 Typical High $3,801.89 | Professional | None | $2,187.76 | $3,090.30 | $3,801.89 |
Medica Setting Facility Modifier None Typical Low $758.58 Median $1,621.81 Typical High $1,995.26 | Facility | None | $758.58 | $1,621.81 | $1,995.26 |
Medica Setting Professional Modifier None Typical Low $1,412.54 Median $3,090.30 Typical High $10,000.00 | Professional | None | $1,412.54 | $3,090.30 | $10,000.00 |
Midlands Setting Professional Modifier None Typical Low $3,090.30 Median $3,090.30 Typical High $3,162.28 | Professional | None | $3,090.30 | $3,090.30 | $3,162.28 |
Midlands Setting Professional Modifier None Typical Low $2,884.03 Median $2,884.03 Typical High $2,884.03 | Professional | None | $2,884.03 | $2,884.03 | $2,884.03 |
Sanford Health Plan Setting Professional Modifier None Typical Low $1,548.82 Median $1,995.26 Typical High $2,754.23 | Professional | None | $1,548.82 | $1,995.26 | $2,754.23 |
United Setting Facility Modifier None Typical Low $758.58 Median $758.58 Typical High $1,202.26 | Facility | None | $758.58 | $758.58 | $1,202.26 |
United Setting Professional Modifier None Typical Low $1,318.26 Median $2,630.27 Typical High $3,715.35 | Professional | None | $1,318.26 | $2,630.27 | $3,715.35 |
Wellmark Setting Professional Modifier None Typical Low $2,884.03 Median $3,311.31 Typical High $3,311.31 | Professional | None | $2,884.03 | $3,311.31 | $3,311.31 |
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 $562.34 Median $562.34 Typical High $676.08 | Professional | 52 · Reduced service | $562.34 | $562.34 | $676.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $223.87 Typical High $275.42 | Professional | 53 · Discontinued | $223.87 | $223.87 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $851.14 Typical High $1,023.29 | Professional | 54 · Surgery only | $851.14 | $851.14 | $1,023.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $169.82 Typical High $204.17 | Professional | 55 · Aftercare only | $169.82 | $169.82 | $204.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $112.20 Typical High $138.04 | Professional | 56 · Pre-op care only | $112.20 | $112.20 | $138.04 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $794.33 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $794.33 | $794.33 | $954.99 |
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
$2,884
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.