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 $93.33 Median $239.88 Typical High $7,244.36 | Facility | None | $93.33 | $239.88 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $91.20 Typical High $104.71 | Professional | None | $91.20 | $91.20 | $104.71 |
Cigna Setting Facility Modifier None Typical Low $165.96 Median $165.96 Typical High $165.96 | Facility | None | $165.96 | $165.96 | $165.96 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $112.20 Typical High $199.53 | Professional | None | $93.33 | $112.20 | $199.53 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,548.13 Median $3,548.13 Typical High $3,548.13 | Facility | None | $3,548.13 | $3,548.13 | $3,548.13 |
United Setting Facility Modifier None Typical Low $501.19 Median $501.19 Typical High $501.19 | Facility | None | $501.19 | $501.19 | $501.19 |
United Setting Professional Modifier None Typical Low $87.10 Median $120.23 Typical High $234.42 | Professional | None | $87.10 | $120.23 | $234.42 |
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 $45.71 Median $45.71 Typical High $48.98 | Professional | 52 · Reduced service | $45.71 | $45.71 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.62 Median $18.62 Typical High $19.50 | Professional | 53 · Discontinued | $18.62 | $18.62 | $19.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $69.18 Typical High $74.13 | Professional | 54 · Surgery only | $69.18 | $69.18 | $74.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.80 Median $13.80 Typical High $14.79 | Professional | 55 · Aftercare only | $13.80 | $13.80 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.33 Median $9.33 Typical High $9.77 | Professional | 56 · Pre-op care only | $9.33 | $9.33 | $9.77 |
Where Delaware sits
The same service costs 3.5 times more in Wisconsin than in New York. 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
$105
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.