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 $758.58 Median $4,365.16 Typical High $6,918.31 | Facility | None | $758.58 | $4,365.16 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $630.96 Median $630.96 Typical High $1,023.29 | Professional | None | $630.96 | $630.96 | $1,023.29 |
Cigna Setting Facility Modifier None Typical Low $1,071.52 Median $1,071.52 Typical High $1,348.96 | Facility | None | $1,071.52 | $1,071.52 | $1,348.96 |
Cigna Setting Professional Modifier None Typical Low $1,202.26 Median $1,737.80 Typical High $2,137.96 | Professional | None | $1,202.26 | $1,737.80 | $2,137.96 |
Medica Setting Facility Modifier None Typical Low $758.58 Median $1,071.52 Typical High $1,737.80 | Facility | None | $758.58 | $1,071.52 | $1,737.80 |
Medica Setting Professional Modifier None Typical Low $812.83 Median $1,737.80 Typical High $5,623.41 | Professional | None | $812.83 | $1,737.80 | $5,623.41 |
Midlands Setting Professional Modifier None Typical Low $1,737.80 Median $1,737.80 Typical High $1,737.80 | Professional | None | $1,737.80 | $1,737.80 | $1,737.80 |
Midlands Setting Professional Modifier None Typical Low $1,621.81 Median $1,621.81 Typical High $1,621.81 | Professional | None | $1,621.81 | $1,621.81 | $1,621.81 |
Sanford Health Plan Setting Professional Modifier None Typical Low $912.01 Median $1,258.93 Typical High $1,513.56 | Professional | None | $912.01 | $1,258.93 | $1,513.56 |
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 $741.31 Median $1,479.11 Typical High $2,089.30 | Professional | None | $741.31 | $1,479.11 | $2,089.30 |
Wellmark Setting Professional Modifier None Typical Low $1,621.81 Median $1,862.09 Typical High $1,862.09 | Professional | None | $1,621.81 | $1,862.09 | $1,862.09 |
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 $316.23 Median $316.23 Typical High $380.19 | Professional | 52 · Reduced service | $316.23 | $316.23 | $380.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $125.89 Median $125.89 Typical High $151.36 | Professional | 53 · Discontinued | $125.89 | $125.89 | $151.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $478.63 Median $478.63 Typical High $575.44 | Professional | 54 · Surgery only | $478.63 | $478.63 | $575.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $95.50 Typical High $114.82 | Professional | 55 · Aftercare only | $95.50 | $95.50 | $114.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $63.10 Median $63.10 Typical High $75.86 | Professional | 56 · Pre-op care only | $63.10 | $63.10 | $75.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $446.68 Median $446.68 Typical High $537.03 | Professional | 78 · Unplanned return to OR | $446.68 | $446.68 | $537.03 |
Where South Dakota sits
The same service costs 5.9 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· 6th of 51
$1,622
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.