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 $83.18 Typical High $7,244.36 | Facility | None | $53.70 | $83.18 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $52.48 Median $83.18 Typical High $144.54 | Professional | None | $52.48 | $83.18 | $144.54 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $77.62 Typical High $151.36 | Facility | None | $56.23 | $77.62 | $151.36 |
Cigna Setting Professional Modifier None Typical Low $58.88 Median $89.13 Typical High $173.78 | Professional | None | $58.88 | $89.13 | $173.78 |
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 $51.29 Median $83.18 Typical High $181.97 | Professional | None | $51.29 | $83.18 | $181.97 |
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 $30.90 Typical High $41.69 | Professional | 52 · Reduced service | $26.92 | $30.90 | $41.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.72 Median $12.30 Typical High $16.60 | Professional | 53 · Discontinued | $10.72 | $12.30 | $16.60 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $39.81 Median $46.77 Typical High $63.10 | Professional | 54 · Surgery only | $39.81 | $46.77 | $63.10 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $9.33 Typical High $12.59 | Professional | 55 · Aftercare only | $7.94 | $9.33 | $12.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.37 Median $6.17 Typical High $8.32 | Professional | 56 · Pre-op care only | $5.37 | $6.17 | $8.32 |
Where Delaware sits
The same service costs 3.2 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· 43rd of 51
$83.18
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.