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 $204.17 Median $295.12 Typical High $7,244.36 | Facility | None | $204.17 | $295.12 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $204.17 Median $288.40 Typical High $346.74 | Professional | None | $204.17 | $288.40 | $346.74 |
Cigna Setting Facility Modifier None Typical Low $562.34 Median $1,000.00 Typical High $1,479.11 | Facility | None | $562.34 | $1,000.00 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $295.12 Typical High $416.87 | Professional | None | $208.93 | $295.12 | $416.87 |
Highmark BCBS Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $309.03 | Professional | None | $309.03 | $309.03 | $309.03 |
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 $194.98 Median $275.42 Typical High $426.58 | Professional | None | $194.98 | $275.42 | $426.58 |
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 $102.33 Median $120.23 Typical High $154.88 | Professional | 52 · Reduced service | $102.33 | $120.23 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $47.86 Typical High $61.66 | Professional | 53 · Discontinued | $41.69 | $47.86 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $177.83 Typical High $234.42 | Professional | 54 · Surgery only | $154.88 | $177.83 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $35.48 Typical High $46.77 | Professional | 55 · Aftercare only | $30.90 | $35.48 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $23.99 Typical High $30.90 | Professional | 56 · Pre-op care only | $20.42 | $23.99 | $30.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $144.54 Median $165.96 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $144.54 | $165.96 | $218.78 |
Highmark BCBS Setting Facility Modifier 59 · Distinct service Typical Low $1,737.80 Median $1,737.80 Typical High $1,737.80 | Facility | 59 · Distinct service | $1,737.80 | $1,737.80 | $1,737.80 |
Where Delaware sits
The same service costs 4.0 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· 47th of 51
$295
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.