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 $398.11 Median $398.11 Typical High $4,365.16 | Facility | None | $398.11 | $398.11 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $338.84 Median $338.84 Typical High $489.78 | Professional | None | $338.84 | $338.84 | $489.78 |
Cigna Setting Facility Modifier None Typical Low $575.44 Median $1,995.26 Typical High $2,398.83 | Facility | None | $575.44 | $1,995.26 | $2,398.83 |
Cigna Setting Professional Modifier None Typical Low $645.65 Median $912.01 Typical High $1,148.15 | Professional | None | $645.65 | $912.01 | $1,148.15 |
Medica Setting Facility Modifier None Typical Low $489.78 Median $933.25 Typical High $2,398.83 | Facility | None | $489.78 | $933.25 | $2,398.83 |
Medica Setting Professional Modifier None Typical Low $407.38 Median $912.01 Typical High $4,677.35 | Professional | None | $407.38 | $912.01 | $4,677.35 |
Midlands Setting Professional Modifier None Typical Low $912.01 Median $912.01 Typical High $933.25 | Professional | None | $912.01 | $912.01 | $933.25 |
Midlands Setting Facility Modifier None Typical Low $1,288.25 Median $2,238.72 Typical High $2,511.89 | Facility | None | $1,288.25 | $2,238.72 | $2,511.89 |
Midlands Setting Professional Modifier None Typical Low $812.83 Median $812.83 Typical High $812.83 | Professional | None | $812.83 | $812.83 | $812.83 |
Sanford Health Plan Setting Professional Modifier None Typical Low $457.09 Median $630.96 Typical High $812.83 | Professional | None | $457.09 | $630.96 | $812.83 |
United Setting Facility Modifier None Typical Low $1,995.26 Median $1,995.26 Typical High $2,398.83 | Facility | None | $1,995.26 | $1,995.26 | $2,398.83 |
United Setting Professional Modifier None Typical Low $389.05 Median $741.31 Typical High $1,096.48 | Professional | None | $389.05 | $741.31 | $1,096.48 |
Wellmark Setting Professional Modifier None Typical Low $891.25 Median $1,023.29 Typical High $1,023.29 | Professional | None | $891.25 | $1,023.29 | $1,023.29 |
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 $169.82 Median $169.82 Typical High $199.53 | Professional | 52 · Reduced service | $169.82 | $169.82 | $199.53 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $67.61 Median $67.61 Typical High $79.43 | Professional | 53 · Discontinued | $67.61 | $67.61 | $79.43 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $251.19 Median $251.19 Typical High $302.00 | Professional | 54 · Surgery only | $251.19 | $251.19 | $302.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $50.12 Median $50.12 Typical High $60.26 | Professional | 55 · Aftercare only | $50.12 | $50.12 | $60.26 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $33.88 Median $33.88 Typical High $39.81 | Professional | 56 · Pre-op care only | $33.88 | $33.88 | $39.81 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $234.42 Median $234.42 Typical High $281.84 | Professional | 78 · Unplanned return to OR | $234.42 | $234.42 | $281.84 |
Where South Dakota sits
The same service costs 5.6 times more in Alaska than in Utah. 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
$912
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.