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 $40.74 Median $67.61 Typical High $7,244.36 | Facility | None | $40.74 | $67.61 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $40.74 Median $67.61 Typical High $107.15 | Professional | None | $40.74 | $67.61 | $107.15 |
Cigna Setting Facility Modifier None Typical Low $39.81 Median $56.23 Typical High $85.11 | Facility | None | $39.81 | $56.23 | $85.11 |
Cigna Setting Professional Modifier None Typical Low $45.71 Median $72.44 Typical High $112.20 | Professional | None | $45.71 | $72.44 | $112.20 |
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 $46.77 Median $69.18 Typical High $109.65 | Professional | None | $46.77 | $69.18 | $109.65 |
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 $20.42 Median $24.55 Typical High $33.88 | Professional | 52 · Reduced service | $20.42 | $24.55 | $33.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.13 Median $9.77 Typical High $13.80 | Professional | 53 · Discontinued | $8.13 | $9.77 | $13.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $30.90 Median $36.31 Typical High $51.29 | Professional | 54 · Surgery only | $30.90 | $36.31 | $51.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.17 Median $7.24 Typical High $10.23 | Professional | 55 · Aftercare only | $6.17 | $7.24 | $10.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.07 Median $4.90 Typical High $6.76 | Professional | 56 · Pre-op care only | $4.07 | $4.90 | $6.76 |
Where Delaware sits
The same service costs 3.1 times more in Wisconsin than in Washington, DC. 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
$70.79
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.