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 $81.28 Median $331.13 Typical High $7,244.36 | Facility | None | $81.28 | $331.13 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $70.79 Median $213.80 Typical High $331.13 | Professional | None | $70.79 | $213.80 | $331.13 |
Cigna Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $125.89 | Facility | None | $125.89 | $125.89 | $125.89 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $213.80 Typical High $436.52 | Professional | None | $75.86 | $213.80 | $436.52 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,412.54 Median $2,951.21 Typical High $3,548.13 | Facility | None | $1,412.54 | $2,951.21 | $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 $74.13 Median $213.80 Typical High $512.86 | Professional | None | $74.13 | $213.80 | $512.86 |
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 $40.74 Median $64.57 Typical High $165.96 | Professional | 52 · Reduced service | $40.74 | $64.57 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $25.70 Typical High $66.07 | Professional | 53 · Discontinued | $16.60 | $25.70 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $95.50 Typical High $251.19 | Professional | 54 · Surgery only | $61.66 | $95.50 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $19.05 Typical High $50.12 | Professional | 55 · Aftercare only | $12.30 | $19.05 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $12.88 Typical High $33.11 | Professional | 56 · Pre-op care only | $8.13 | $12.88 | $33.11 |
Where Delaware sits
The same service costs 4.2 times more in Washington than in Virginia. 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· 36th of 51
$214
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.