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 $53.70 Median $87.10 Typical High $7,244.36 | Facility | None | $53.70 | $87.10 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $53.70 Median $63.10 Typical High $87.10 | Professional | None | $53.70 | $63.10 | $87.10 |
Cigna Setting Facility Modifier None Typical Low $85.11 Median $501.19 Typical High $1,412.54 | Facility | None | $85.11 | $501.19 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $53.70 Median $89.13 Typical High $125.89 | Professional | None | $53.70 | $89.13 | $125.89 |
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 $52.48 Median $81.28 Typical High $123.03 | Professional | None | $52.48 | $81.28 | $123.03 |
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 $26.92 Median $28.84 Typical High $43.65 | Professional | 52 · Reduced service | $26.92 | $28.84 | $43.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.72 Median $11.48 Typical High $17.38 | Professional | 53 · Discontinued | $10.72 | $11.48 | $17.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $39.81 Median $42.66 Typical High $66.07 | Professional | 54 · Surgery only | $39.81 | $42.66 | $66.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $8.51 Typical High $13.18 | Professional | 55 · Aftercare only | $7.94 | $8.51 | $13.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.37 Median $5.75 Typical High $8.71 | Professional | 56 · Pre-op care only | $5.37 | $5.75 | $8.71 |
Where Delaware sits
The same service costs 3.5 times more in Wisconsin than in New York. 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· 44th of 51
$87.10
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.