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 $4,365.16 Median $4,365.16 Typical High $4,786.30 | Facility | None | $4,365.16 | $4,365.16 | $4,786.30 |
Aetna Setting Professional Modifier None Typical Low $3,890.45 Median $3,890.45 Typical High $5,011.87 | Professional | None | $3,890.45 | $3,890.45 | $5,011.87 |
Cigna Setting Facility Modifier None Typical Low $6,606.93 Median $6,606.93 Typical High $8,317.64 | Facility | None | $6,606.93 | $6,606.93 | $8,317.64 |
Cigna Setting Professional Modifier None Typical Low $7,585.78 Median $10,715.19 Typical High $13,182.57 | Professional | None | $7,585.78 | $10,715.19 | $13,182.57 |
Medica Setting Facility Modifier None Typical Low $758.58 Median $5,623.41 Typical High $6,606.93 | Facility | None | $758.58 | $5,623.41 | $6,606.93 |
Medica Setting Professional Modifier None Typical Low $5,128.61 Median $10,964.78 Typical High $35,481.34 | Professional | None | $5,128.61 | $10,964.78 | $35,481.34 |
Midlands Setting Professional Modifier None Typical Low $10,964.78 Median $10,964.78 Typical High $10,964.78 | Professional | None | $10,964.78 | $10,964.78 | $10,964.78 |
Midlands Setting Professional Modifier None Typical Low $10,232.93 Median $10,232.93 Typical High $10,232.93 | Professional | None | $10,232.93 | $10,232.93 | $10,232.93 |
Sanford Health Plan Setting Professional Modifier None Typical Low $4,786.30 Median $7,079.46 Typical High $9,549.93 | Professional | None | $4,786.30 | $7,079.46 | $9,549.93 |
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 $4,677.35 Median $9,332.54 Typical High $13,182.57 | Professional | None | $4,677.35 | $9,332.54 | $13,182.57 |
Wellmark Setting Professional Modifier None Typical Low $10,000.00 Median $11,481.54 Typical High $11,481.54 | Professional | None | $10,000.00 | $11,481.54 | $11,481.54 |
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 $1,949.84 Median $1,949.84 Typical High $2,398.83 | Professional | 52 · Reduced service | $1,949.84 | $1,949.84 | $2,398.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $794.33 Median $794.33 Typical High $954.99 | Professional | 53 · Discontinued | $794.33 | $794.33 | $954.99 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,951.21 Median $2,951.21 Typical High $3,630.78 | Professional | 54 · Surgery only | $2,951.21 | $2,951.21 | $3,630.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $588.84 Median $588.84 Typical High $724.44 | Professional | 55 · Aftercare only | $588.84 | $588.84 | $724.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $389.05 Median $389.05 Typical High $478.63 | Professional | 56 · Pre-op care only | $389.05 | $389.05 | $478.63 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,754.23 Median $2,754.23 Typical High $3,388.44 | Professional | 78 · Unplanned return to OR | $2,754.23 | $2,754.23 | $3,388.44 |
Where South Dakota sits
The same service costs 20.0 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
$10,000
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.