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 $1,258.93 Median $1,258.93 Typical High $4,365.16 | Facility | None | $1,258.93 | $1,258.93 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $1,023.29 Median $1,023.29 Typical High $1,258.93 | Professional | None | $1,023.29 | $1,023.29 | $1,258.93 |
Cigna Setting Facility Modifier None Typical Low $1,737.80 Median $1,737.80 Typical High $2,187.76 | Facility | None | $1,737.80 | $1,737.80 | $2,187.76 |
Cigna Setting Professional Modifier None Typical Low $1,995.26 Median $2,818.38 Typical High $3,467.37 | Professional | None | $1,995.26 | $2,818.38 | $3,467.37 |
Medica Setting Facility Modifier None Typical Low $758.58 Median $1,479.11 Typical High $1,995.26 | Facility | None | $758.58 | $1,479.11 | $1,995.26 |
Medica Setting Professional Modifier None Typical Low $1,288.25 Median $2,818.38 Typical High $9,120.11 | Professional | None | $1,288.25 | $2,818.38 | $9,120.11 |
Midlands Setting Professional Modifier None Typical Low $2,818.38 Median $2,818.38 Typical High $2,884.03 | Professional | None | $2,818.38 | $2,818.38 | $2,884.03 |
Midlands Setting Professional Modifier None Typical Low $2,630.27 Median $2,630.27 Typical High $2,630.27 | Professional | None | $2,630.27 | $2,630.27 | $2,630.27 |
Sanford Health Plan Setting Professional Modifier None Typical Low $1,348.96 Median $1,819.70 Typical High $2,454.71 | Professional | None | $1,348.96 | $1,819.70 | $2,454.71 |
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 $1,202.26 Median $2,398.83 Typical High $3,388.44 | Professional | None | $1,202.26 | $2,398.83 | $3,388.44 |
Wellmark Setting Professional Modifier None Typical Low $2,630.27 Median $3,019.95 Typical High $3,019.95 | Professional | None | $2,630.27 | $3,019.95 | $3,019.95 |
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 $512.86 Median $512.86 Typical High $616.60 | Professional | 52 · Reduced service | $512.86 | $512.86 | $616.60 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $204.17 Median $204.17 Typical High $251.19 | Professional | 53 · Discontinued | $204.17 | $204.17 | $251.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $776.25 Typical High $933.25 | Professional | 54 · Surgery only | $776.25 | $776.25 | $933.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $154.88 Median $154.88 Typical High $186.21 | Professional | 55 · Aftercare only | $154.88 | $154.88 | $186.21 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $102.33 Median $102.33 Typical High $125.89 | Professional | 56 · Pre-op care only | $102.33 | $102.33 | $125.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $724.44 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $724.44 | $724.44 | $870.96 |
Where South Dakota sits
The same service costs 22.4 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
$2,630
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.