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 $407.38 Typical High $7,244.36 | Facility | None | $165.96 | $407.38 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $165.96 Median $177.83 Typical High $407.38 | Professional | None | $165.96 | $177.83 | $407.38 |
Cigna Setting Facility Modifier None Typical Low $331.13 Median $501.19 Typical High $1,288.25 | Facility | None | $331.13 | $501.19 | $1,288.25 |
Cigna Setting Professional Modifier None Typical Low $165.96 Median $316.23 Typical High $645.65 | Professional | None | $165.96 | $316.23 | $645.65 |
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 $158.49 Median $331.13 Typical High $630.96 | Professional | None | $158.49 | $331.13 | $630.96 |
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 $83.18 Median $89.13 Typical High $204.17 | Professional | 52 · Reduced service | $83.18 | $89.13 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.11 Median $35.48 Typical High $81.28 | Professional | 53 · Discontinued | $33.11 | $35.48 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $125.89 Median $134.90 Typical High $302.00 | Professional | 54 · Surgery only | $125.89 | $134.90 | $302.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.12 Median $26.92 Typical High $61.66 | Professional | 55 · Aftercare only | $25.12 | $26.92 | $61.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.60 Median $17.78 Typical High $40.74 | Professional | 56 · Pre-op care only | $16.60 | $17.78 | $40.74 |
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· 36th of 51
$380
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.