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 $58.88 Median $95.50 Typical High $7,244.36 | Facility | None | $58.88 | $95.50 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $58.88 Median $91.20 Typical High $154.88 | Professional | None | $58.88 | $91.20 | $154.88 |
Cigna Setting Facility Modifier None Typical Low $64.57 Median $102.33 Typical High $588.84 | Facility | None | $64.57 | $102.33 | $588.84 |
Cigna Setting Professional Modifier None Typical Low $63.10 Median $87.10 Typical High $141.25 | Professional | None | $63.10 | $87.10 | $141.25 |
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 $64.57 Median $95.50 Typical High $151.36 | Professional | None | $64.57 | $95.50 | $151.36 |
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 $29.51 Median $33.88 Typical High $47.86 | Professional | 52 · Reduced service | $29.51 | $33.88 | $47.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.75 Median $13.80 Typical High $19.05 | Professional | 53 · Discontinued | $11.75 | $13.80 | $19.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $44.67 Median $51.29 Typical High $70.79 | Professional | 54 · Surgery only | $44.67 | $51.29 | $70.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.91 Median $10.23 Typical High $14.45 | Professional | 55 · Aftercare only | $8.91 | $10.23 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.89 Median $6.76 Typical High $9.55 | Professional | 56 · Pre-op care only | $5.89 | $6.76 | $9.55 |
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· 46th of 51
$95.50
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.