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 $141.25 Median $363.08 Typical High $933.25 | Facility | None | $141.25 | $363.08 | $933.25 |
Aetna Setting Professional Modifier None Typical Low $134.90 Median $223.87 Typical High $371.54 | Professional | None | $134.90 | $223.87 | $371.54 |
Cigna Setting Facility Modifier None Typical Low $58.88 Median $147.91 Typical High $218.78 | Facility | None | $58.88 | $147.91 | $218.78 |
Cigna Setting Professional Modifier None Typical Low $123.03 Median $251.19 Typical High $380.19 | Professional | None | $123.03 | $251.19 | $380.19 |
Highmark BCBS Setting Facility Modifier None Typical Low $239.88 Median $501.19 Typical High $912.01 | Facility | None | $239.88 | $501.19 | $912.01 |
Highmark BCBS Setting Professional Modifier None Typical Low $144.54 Median $331.13 Typical High $1,174.90 | Professional | None | $144.54 | $331.13 | $1,174.90 |
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 $114.82 Median $194.98 Typical High $338.84 | Professional | None | $114.82 | $194.98 | $338.84 |
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 $70.79 Median $79.43 Typical High $181.97 | Professional | 52 · Reduced service | $70.79 | $79.43 | $181.97 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $31.62 Typical High $72.44 | Professional | 53 · Discontinued | $28.18 | $31.62 | $72.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $117.49 Typical High $269.15 | Professional | 54 · Surgery only | $107.15 | $117.49 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $23.44 Typical High $53.70 | Professional | 55 · Aftercare only | $21.38 | $23.44 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $15.85 Typical High $36.31 | Professional | 56 · Pre-op care only | $14.13 | $15.85 | $36.31 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $109.65 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $100.00 | $109.65 | $251.19 |
Where Delaware sits
The same service costs 3.6 times more in Wisconsin than in Kentucky. 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· 45th of 51
$209
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.