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 $52.48 Median $138.04 Typical High $7,244.36 | Facility | None | $52.48 | $138.04 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $52.48 Median $95.50 Typical High $138.04 | Professional | None | $52.48 | $95.50 | $138.04 |
Cigna Setting Facility Modifier None Typical Low $74.13 Median $109.65 Typical High $588.84 | Facility | None | $74.13 | $109.65 | $588.84 |
Cigna Setting Professional Modifier None Typical Low $64.57 Median $91.20 Typical High $154.88 | Professional | None | $64.57 | $91.20 | $154.88 |
Highmark BCBS Setting Facility Modifier None Typical Low $457.09 Median $1,230.27 Typical High $5,370.32 | Facility | None | $457.09 | $1,230.27 | $5,370.32 |
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 $53.70 Median $97.72 Typical High $165.96 | Professional | None | $53.70 | $97.72 | $165.96 |
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 $26.30 Median $28.18 Typical High $50.12 | Professional | 52 · Reduced service | $26.30 | $28.18 | $50.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $11.22 Typical High $20.42 | Professional | 53 · Discontinued | $10.47 | $11.22 | $20.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.90 Median $41.69 Typical High $75.86 | Professional | 54 · Surgery only | $38.90 | $41.69 | $75.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $8.51 Typical High $15.14 | Professional | 55 · Aftercare only | $7.76 | $8.51 | $15.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $5.62 Typical High $10.00 | Professional | 56 · Pre-op care only | $5.25 | $5.62 | $10.00 |
Where Delaware sits
The same service costs 2.8 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· 38th of 51
$100
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.