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 $165.96 Median $4,073.80 Typical High $16,218.10 | Facility | None | $165.96 | $4,073.80 | $16,218.10 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $426.58 Typical High $758.58 | Professional | None | $162.18 | $426.58 | $758.58 |
Cigna Setting Facility Modifier None Typical Low $218.78 Median $218.78 Typical High $218.78 | Facility | None | $218.78 | $218.78 | $218.78 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $389.05 Typical High $977.24 | Professional | None | $147.91 | $389.05 | $977.24 |
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 $128.82 Median $371.54 Typical High $1,000.00 | Professional | None | $128.82 | $371.54 | $1,000.00 |
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 $81.28 Median $109.65 Typical High $380.19 | Professional | 52 · Reduced service | $81.28 | $109.65 | $380.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.11 Median $43.65 Typical High $151.36 | Professional | 53 · Discontinued | $33.11 | $43.65 | $151.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $162.18 Typical High $562.34 | Professional | 54 · Surgery only | $123.03 | $162.18 | $562.34 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $32.36 Typical High $114.82 | Professional | 55 · Aftercare only | $24.55 | $32.36 | $114.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $21.88 Typical High $75.86 | Professional | 56 · Pre-op care only | $16.22 | $21.88 | $75.86 |
Where Delaware sits
The same service costs 3.8 times more in Wisconsin than in Nebraska. 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· 42nd of 51
$407
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.