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 $1,000.00 Median $1,000.00 Typical High $4,365.16 | Facility | None | $1,000.00 | $1,000.00 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $831.76 Median $831.76 Typical High $1,000.00 | Professional | None | $831.76 | $831.76 | $1,000.00 |
Cigna Setting Facility Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $1,778.28 | Facility | None | $1,412.54 | $1,412.54 | $1,778.28 |
Cigna Setting Professional Modifier None Typical Low $1,584.89 Median $2,238.72 Typical High $2,818.38 | Professional | None | $1,584.89 | $2,238.72 | $2,818.38 |
Medica Setting Facility Modifier None Typical Low $758.58 Median $1,202.26 Typical High $1,995.26 | Facility | None | $758.58 | $1,202.26 | $1,995.26 |
Medica Setting Professional Modifier None Typical Low $977.24 Median $2,238.72 Typical High $7,244.36 | Professional | None | $977.24 | $2,238.72 | $7,244.36 |
Midlands Setting Professional Modifier None Typical Low $2,238.72 Median $2,238.72 Typical High $2,238.72 | Professional | None | $2,238.72 | $2,238.72 | $2,238.72 |
Midlands Setting Professional Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Professional | None | $2,089.30 | $2,089.30 | $2,089.30 |
Sanford Health Plan Setting Professional Modifier None Typical Low $1,174.90 Median $1,445.44 Typical High $1,949.84 | Professional | None | $1,174.90 | $1,445.44 | $1,949.84 |
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 $954.99 Median $1,949.84 Typical High $2,754.23 | Professional | None | $954.99 | $1,949.84 | $2,754.23 |
Wellmark Setting Professional Modifier None Typical Low $2,187.76 Median $2,511.89 Typical High $2,511.89 | Professional | None | $2,187.76 | $2,511.89 | $2,511.89 |
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 $416.87 Median $416.87 Typical High $501.19 | Professional | 52 · Reduced service | $416.87 | $416.87 | $501.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $165.96 Median $165.96 Typical High $199.53 | Professional | 53 · Discontinued | $165.96 | $165.96 | $199.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $630.96 Typical High $741.31 | Professional | 54 · Surgery only | $630.96 | $630.96 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $125.89 Typical High $147.91 | Professional | 55 · Aftercare only | $125.89 | $125.89 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $83.18 Typical High $100.00 | Professional | 56 · Pre-op care only | $83.18 | $83.18 | $100.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $588.84 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $588.84 | $588.84 | $691.83 |
Where South Dakota sits
The same service costs 4.9 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· 4th of 51
$2,188
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.