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 $288.40 Typical High $7,244.36 | Facility | None | $194.98 | $288.40 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $239.88 Typical High $288.40 | Professional | None | $194.98 | $239.88 | $288.40 |
Cigna Setting Facility Modifier None Typical Low $208.93 Median $323.59 Typical High $1,288.25 | Facility | None | $208.93 | $323.59 | $1,288.25 |
Cigna Setting Professional Modifier None Typical Low $229.09 Median $302.00 Typical High $549.54 | Professional | None | $229.09 | $302.00 | $549.54 |
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 $204.17 Median $295.12 Typical High $489.78 | Professional | None | $204.17 | $295.12 | $489.78 |
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 $120.23 Typical High $144.54 | Professional | 52 · Reduced service | $97.72 | $120.23 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $47.86 Typical High $57.54 | Professional | 53 · Discontinued | $38.90 | $47.86 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $181.97 Typical High $218.78 | Professional | 54 · Surgery only | $147.91 | $181.97 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $36.31 Typical High $43.65 | Professional | 55 · Aftercare only | $29.51 | $36.31 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $23.99 Typical High $28.84 | Professional | 56 · Pre-op care only | $19.50 | $23.99 | $28.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $169.82 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $138.04 | $169.82 | $204.17 |
Where Delaware sits
The same service costs 3.7 times more in Wisconsin than in Texas. 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
$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.