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 $147.91 Median $4,073.80 Typical High $16,218.10 | Facility | None | $147.91 | $4,073.80 | $16,218.10 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $199.53 Typical High $707.95 | Professional | None | $144.54 | $199.53 | $707.95 |
Cigna Setting Facility Modifier None Typical Low $190.55 Median $190.55 Typical High $190.55 | Facility | None | $190.55 | $190.55 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $131.83 Median $380.19 Typical High $870.96 | Professional | None | $131.83 | $380.19 | $870.96 |
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 $114.82 Median $323.59 Typical High $870.96 | Professional | None | $114.82 | $323.59 | $870.96 |
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 $72.44 Median $97.72 Typical High $354.81 | Professional | 52 · Reduced service | $72.44 | $97.72 | $354.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $39.81 Typical High $141.25 | Professional | 53 · Discontinued | $28.84 | $39.81 | $141.25 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $147.91 Typical High $537.03 | Professional | 54 · Surgery only | $109.65 | $147.91 | $537.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $29.51 Typical High $107.15 | Professional | 55 · Aftercare only | $21.88 | $29.51 | $107.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $19.95 Typical High $70.79 | Professional | 56 · Pre-op care only | $14.45 | $19.95 | $70.79 |
Where Delaware sits
The same service costs 4.0 times more in Wisconsin than in Maryland. 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· 41st of 51
$380
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.