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 $173.78 Median $4,073.80 Typical High $7,244.36 | Facility | None | $173.78 | $4,073.80 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $173.78 Typical High $181.97 | Professional | None | $169.82 | $173.78 | $181.97 |
Cigna Setting Facility Modifier None Typical Low $275.42 Median $676.08 Typical High $2,290.87 | Facility | None | $275.42 | $676.08 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $154.88 Median $173.78 Typical High $316.23 | Professional | None | $154.88 | $173.78 | $316.23 |
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 $151.36 Median $173.78 Typical High $251.19 | Professional | None | $151.36 | $173.78 | $251.19 |
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 $87.10 Typical High $91.20 | Professional | 52 · Reduced service | $83.18 | $87.10 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $34.67 Typical High $36.31 | Professional | 53 · Discontinued | $33.88 | $34.67 | $36.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $125.89 Median $128.82 Typical High $134.90 | Professional | 54 · Surgery only | $125.89 | $128.82 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.12 Median $25.70 Typical High $27.54 | Professional | 55 · Aftercare only | $25.12 | $25.70 | $27.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $17.38 Typical High $18.20 | Professional | 56 · Pre-op care only | $16.98 | $17.38 | $18.20 |
Where Delaware sits
The same service costs 4.5 times more in Alaska 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· 48th of 51
$174
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.