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 $194.98 Median $295.12 Typical High $7,244.36 | Facility | None | $194.98 | $295.12 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $229.09 Typical High $295.12 | Professional | None | $194.98 | $229.09 | $295.12 |
Cigna Setting Facility Modifier None Typical Low $323.59 Median $478.63 Typical High $1,288.25 | Facility | None | $323.59 | $478.63 | $1,288.25 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $275.42 Typical High $489.78 | Professional | None | $204.17 | $275.42 | $489.78 |
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 $199.53 Median $295.12 Typical High $478.63 | Professional | None | $199.53 | $295.12 | $478.63 |
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 $97.72 Median $114.82 Typical High $147.91 | Professional | 52 · Reduced service | $97.72 | $114.82 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $45.71 Typical High $58.88 | Professional | 53 · Discontinued | $38.90 | $45.71 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $169.82 Typical High $218.78 | Professional | 54 · Surgery only | $147.91 | $169.82 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $33.88 Typical High $43.65 | Professional | 55 · Aftercare only | $29.51 | $33.88 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $22.91 Typical High $29.51 | Professional | 56 · Pre-op care only | $19.50 | $22.91 | $29.51 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $158.49 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $138.04 | $158.49 | $204.17 |
Where Delaware sits
The same service costs 3.7 times more in Wisconsin than in Utah. 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
$288
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.