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 $144.54 Median $199.53 Typical High $3,235.94 | Facility | None | $144.54 | $199.53 | $3,235.94 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $190.55 Typical High $323.59 | Professional | None | $144.54 | $190.55 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $416.87 Median $933.25 Typical High $1,445.44 | Facility | None | $416.87 | $933.25 | $1,445.44 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $218.78 Typical High $309.03 | Professional | None | $138.04 | $218.78 | $309.03 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,047.13 Median $1,513.56 Typical High $8,709.64 | Facility | None | $1,047.13 | $1,513.56 | $8,709.64 |
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 $128.82 Median $181.97 Typical High $281.84 | Professional | None | $128.82 | $181.97 | $281.84 |
7 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 $70.79 Median $83.18 Typical High $102.33 | Professional | 52 · Reduced service | $70.79 | $83.18 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $33.11 Typical High $41.69 | Professional | 53 · Discontinued | $28.84 | $33.11 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $123.03 Typical High $154.88 | Professional | 54 · Surgery only | $107.15 | $123.03 | $154.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $24.55 Typical High $30.90 | Professional | 55 · Aftercare only | $21.38 | $24.55 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $16.60 Typical High $20.89 | Professional | 56 · Pre-op care only | $14.45 | $16.60 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $114.82 Typical High $144.54 | Professional | 78 · Unplanned return to OR | $100.00 | $114.82 | $144.54 |
Highmark BCBS Setting Professional Modifier 51 · Multiple procedures + 59 · Distinct service + 79 · Unrelated procedure after surgery Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | 51 · Multiple procedures + 59 · Distinct service + 79 · Unrelated procedure after surgery | $223.87 | $223.87 | $223.87 |
Where Delaware sits
The same service costs 4.6 times more in Alaska 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· 42nd of 51
$214
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.