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 $81.28 Median $141.25 Typical High $7,244.36 | Facility | None | $81.28 | $141.25 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $81.28 Median $141.25 Typical High $251.19 | Professional | None | $81.28 | $141.25 | $251.19 |
Cigna Setting Facility Modifier None Typical Low $331.13 Median $467.74 Typical High $616.60 | Facility | None | $331.13 | $467.74 | $616.60 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $141.25 Typical High $229.09 | Professional | None | $93.33 | $141.25 | $229.09 |
United Setting Facility Modifier None Typical Low $229.09 Median $398.11 Typical High $1,698.24 | Facility | None | $229.09 | $398.11 | $1,698.24 |
United Setting Professional Modifier None Typical Low $79.43 Median $138.04 Typical High $245.47 | Professional | None | $79.43 | $138.04 | $245.47 |
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 $40.74 Median $42.66 Typical High $70.79 | Professional | 52 · Reduced service | $40.74 | $42.66 | $70.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.22 Median $16.98 Typical High $28.18 | Professional | 53 · Discontinued | $16.22 | $16.98 | $28.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $60.26 Median $64.57 Typical High $107.15 | Professional | 54 · Surgery only | $60.26 | $64.57 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.02 Median $12.88 Typical High $21.38 | Professional | 55 · Aftercare only | $12.02 | $12.88 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $8.51 Typical High $14.13 | Professional | 56 · Pre-op care only | $8.13 | $8.51 | $14.13 |
Where Delaware sits
The same service costs 3.6 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· 32nd of 51
$158
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.