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 $128.82 Median $269.15 Typical High $7,244.36 | Facility | None | $128.82 | $269.15 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $128.82 Median $141.25 Typical High $269.15 | Professional | None | $128.82 | $141.25 | $269.15 |
Cigna Setting Facility Modifier None Typical Low $229.09 Median $346.74 Typical High $1,288.25 | Facility | None | $229.09 | $346.74 | $1,288.25 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $239.88 Typical High $416.87 | Professional | None | $134.90 | $239.88 | $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 $128.82 Median $218.78 Typical High $380.19 | Professional | None | $128.82 | $218.78 | $380.19 |
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 $64.57 Median $70.79 Typical High $134.90 | Professional | 52 · Reduced service | $64.57 | $70.79 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $28.18 Typical High $54.95 | Professional | 53 · Discontinued | $25.70 | $28.18 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $107.15 Typical High $204.17 | Professional | 54 · Surgery only | $97.72 | $107.15 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $21.38 Typical High $40.74 | Professional | 55 · Aftercare only | $19.50 | $21.38 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $14.13 Typical High $26.92 | Professional | 56 · Pre-op care only | $12.88 | $14.13 | $26.92 |
Where Delaware sits
The same service costs 3.2 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· 48th of 51
$240
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.