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 $1,148.15 Median $1,148.15 Typical High $1,380.38 | Professional | None | $1,148.15 | $1,148.15 | $1,380.38 |
Cigna Setting Facility Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $2,398.83 | Facility | None | $1,949.84 | $1,949.84 | $2,398.83 |
Cigna Setting Professional Modifier None Typical Low $2,187.76 Median $3,090.30 Typical High $3,890.45 | Professional | None | $2,187.76 | $3,090.30 | $3,890.45 |
Medica Setting Facility Modifier None Typical Low $758.58 Median $1,659.59 Typical High $1,995.26 | Facility | None | $758.58 | $1,659.59 | $1,995.26 |
Medica Setting Professional Modifier None Typical Low $1,445.44 Median $3,162.28 Typical High $12,022.64 | Professional | None | $1,445.44 | $3,162.28 | $12,022.64 |
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 |
Midlands Setting Professional Modifier None Typical Low $2,951.21 Median $2,951.21 Typical High $2,951.21 | Professional | None | $2,951.21 | $2,951.21 | $2,951.21 |
Sanford Health Plan Setting Professional Modifier None Typical Low $1,380.38 Median $2,041.74 Typical High $2,754.23 | Professional | None | $1,380.38 | $2,041.74 | $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 $1,348.96 Median $2,691.53 Typical High $3,801.89 | Professional | None | $1,348.96 | $2,691.53 | $3,801.89 |
Wellmark Setting Professional Modifier None Typical Low $2,951.21 Median $3,388.44 Typical High $3,388.44 | Professional | None | $2,951.21 | $3,388.44 | $3,388.44 |
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 $575.44 Median $575.44 Typical High $691.83 | Professional | 52 · Reduced service | $575.44 | $575.44 | $691.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $229.09 Typical High $275.42 | Professional | 53 · Discontinued | $229.09 | $229.09 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $851.14 Typical High $1,047.13 | Professional | 54 · Surgery only | $851.14 | $851.14 | $1,047.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $173.78 Median $173.78 Typical High $208.93 | Professional | 55 · Aftercare only | $173.78 | $173.78 | $208.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $114.82 Typical High $138.04 | Professional | 56 · Pre-op care only | $114.82 | $114.82 | $138.04 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $794.33 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $794.33 | $794.33 | $977.24 |
Where South Dakota sits
The same service costs 5.2 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
$2,951
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.