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 $1,479.11 Median $1,479.11 Typical High $4,365.16 | Facility | None | $1,479.11 | $1,479.11 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,479.11 | Professional | None | $1,230.27 | $1,230.27 | $1,479.11 |
Cigna Setting Facility Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,630.27 | Facility | None | $2,089.30 | $2,089.30 | $2,630.27 |
Cigna Setting Professional Modifier None Typical Low $2,344.23 Median $3,388.44 Typical High $4,168.69 | Professional | None | $2,344.23 | $3,388.44 | $4,168.69 |
Medica Setting Facility Modifier None Typical Low $1,737.80 Median $3,235.94 Typical High $3,890.45 | Facility | None | $1,737.80 | $3,235.94 | $3,890.45 |
Medica Setting Professional Modifier None Typical Low $1,479.11 Median $3,388.44 Typical High $10,964.78 | Professional | None | $1,479.11 | $3,388.44 | $10,964.78 |
Midlands Setting Professional Modifier None Typical Low $3,388.44 Median $3,388.44 Typical High $3,467.37 | Professional | None | $3,388.44 | $3,388.44 | $3,467.37 |
Midlands Setting Professional Modifier None Typical Low $3,162.28 Median $3,162.28 Typical High $3,162.28 | Professional | None | $3,162.28 | $3,162.28 | $3,162.28 |
Sanford Health Plan Setting Professional Modifier None Typical Low $1,548.82 Median $2,187.76 Typical High $2,951.21 | Professional | None | $1,548.82 | $2,187.76 | $2,951.21 |
United Setting Facility Modifier None Typical Low $3,235.94 Median $3,235.94 Typical High $3,890.45 | Facility | None | $3,235.94 | $3,235.94 | $3,890.45 |
United Setting Professional Modifier None Typical Low $1,445.44 Median $2,951.21 Typical High $4,073.80 | Professional | None | $1,445.44 | $2,951.21 | $4,073.80 |
Wellmark Setting Professional Modifier None Typical Low $3,162.28 Median $3,630.78 Typical High $3,630.78 | Professional | None | $3,162.28 | $3,630.78 | $3,630.78 |
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 $616.60 Median $616.60 Typical High $741.31 | Professional | 52 · Reduced service | $616.60 | $616.60 | $741.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $245.47 Typical High $295.12 | Professional | 53 · Discontinued | $245.47 | $245.47 | $295.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $933.25 Typical High $1,122.02 | Professional | 54 · Surgery only | $933.25 | $933.25 | $1,122.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $186.21 Typical High $223.87 | Professional | 55 · Aftercare only | $186.21 | $186.21 | $223.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $123.03 Typical High $147.91 | Professional | 56 · Pre-op care only | $123.03 | $123.03 | $147.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $870.96 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $870.96 | $870.96 | $1,047.13 |
Where South Dakota sits
The same service costs 6.3 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
$3,236
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.