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 $69.18 Median $239.88 Typical High $7,244.36 | Facility | None | $69.18 | $239.88 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $69.18 Median $72.44 Typical High $239.88 | Professional | None | $69.18 | $72.44 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $120.23 Median $707.95 Typical High $2,290.87 | Facility | None | $120.23 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $186.21 Typical High $416.87 | Professional | None | $93.33 | $186.21 | $416.87 |
United Setting Facility Modifier None Typical Low $83.18 Median $114.82 Typical High $1,698.24 | Facility | None | $83.18 | $114.82 | $1,698.24 |
United Setting Professional Modifier None Typical Low $74.13 Median $218.78 Typical High $426.58 | Professional | None | $74.13 | $218.78 | $426.58 |
5 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 $34.67 Median $36.31 Typical High $120.23 | Professional | 52 · Reduced service | $34.67 | $36.31 | $120.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.80 Median $14.45 Typical High $47.86 | Professional | 53 · Discontinued | $13.80 | $14.45 | $47.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $51.29 Median $54.95 Typical High $177.83 | Professional | 54 · Surgery only | $51.29 | $54.95 | $177.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.23 Median $10.96 Typical High $35.48 | Professional | 55 · Aftercare only | $10.23 | $10.96 | $35.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.92 Median $7.24 Typical High $23.99 | Professional | 56 · Pre-op care only | $6.92 | $7.24 | $23.99 |
Where Delaware sits
The same service costs 4.5 times more in Oklahoma than in Nebraska. 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.
Delaware· 47th of 51
$191
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.