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 $131.83 Median $251.19 Typical High $7,244.36 | Facility | None | $131.83 | $251.19 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $204.17 Typical High $281.84 | Professional | None | $131.83 | $204.17 | $281.84 |
Cigna Setting Facility Modifier None Typical Low $162.18 Median $239.88 Typical High $1,819.70 | Facility | None | $162.18 | $239.88 | $1,819.70 |
Cigna Setting Professional Modifier None Typical Low $125.89 Median $269.15 Typical High $707.95 | Professional | None | $125.89 | $269.15 | $707.95 |
United Setting Facility Modifier None Typical Low $416.87 Median $616.60 Typical High $2,398.83 | Facility | None | $416.87 | $616.60 | $2,398.83 |
United Setting Professional Modifier None Typical Low $125.89 Median $281.84 Typical High $794.33 | Professional | None | $125.89 | $281.84 | $794.33 |
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 $63.10 Median $66.07 Typical High $125.89 | Professional | 52 · Reduced service | $63.10 | $66.07 | $125.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $26.30 Typical High $50.12 | Professional | 53 · Discontinued | $25.12 | $26.30 | $50.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $100.00 Typical High $186.21 | Professional | 54 · Surgery only | $93.33 | $100.00 | $186.21 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $19.95 Typical High $37.15 | Professional | 55 · Aftercare only | $18.62 | $19.95 | $37.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $13.18 Typical High $25.12 | Professional | 56 · Pre-op care only | $12.59 | $13.18 | $25.12 |
Where Delaware sits
The same service costs 3.2 times more in Oklahoma than in Texas. 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· 38th of 51
$251
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.