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 $128.82 Median $204.17 Typical High $7,244.36 | Facility | None | $128.82 | $204.17 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $128.82 Median $190.55 Typical High $245.47 | Professional | None | $128.82 | $190.55 | $245.47 |
Cigna Setting Facility Modifier None Typical Low $169.82 Median $245.47 Typical High $588.84 | Facility | None | $169.82 | $245.47 | $588.84 |
Cigna Setting Professional Modifier None Typical Low $128.82 Median $199.53 Typical High $281.84 | Professional | None | $128.82 | $199.53 | $281.84 |
Highmark BCBS Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $229.09 | Professional | None | $223.87 | $223.87 | $229.09 |
United Setting Facility Modifier None Typical Low $229.09 Median $398.11 Typical High $1,698.24 | Facility | None | $229.09 | $398.11 | $1,698.24 |
United Setting Professional Modifier None Typical Low $123.03 Median $177.83 Typical High $288.40 | Professional | None | $123.03 | $177.83 | $288.40 |
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 $64.57 Median $75.86 Typical High $104.71 | Professional | 52 · Reduced service | $64.57 | $75.86 | $104.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $30.20 Typical High $41.69 | Professional | 53 · Discontinued | $25.70 | $30.20 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $112.20 Typical High $158.49 | Professional | 54 · Surgery only | $97.72 | $112.20 | $158.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $22.91 Typical High $31.62 | Professional | 55 · Aftercare only | $19.50 | $22.91 | $31.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $15.14 Typical High $20.89 | Professional | 56 · Pre-op care only | $12.88 | $15.14 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $104.71 Typical High $147.91 | Professional | 78 · Unplanned return to OR | $91.20 | $104.71 | $147.91 |
Highmark BCBS Setting Facility Modifier 59 · Distinct service Typical Low $181.97 Median $181.97 Typical High $181.97 | Facility | 59 · Distinct service | $181.97 | $181.97 | $181.97 |
Where Delaware sits
The same service costs 3.4 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· 44th of 51
$200
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.