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 $239.88 Median $302.00 Typical High $7,244.36 | Facility | None | $239.88 | $302.00 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $239.88 Median $302.00 Typical High $407.38 | Professional | None | $239.88 | $302.00 | $407.38 |
Cigna Setting Facility Modifier None Typical Low $229.09 Median $363.08 Typical High $588.84 | Facility | None | $229.09 | $363.08 | $588.84 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $338.84 Typical High $512.86 | Professional | None | $281.84 | $338.84 | $512.86 |
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 $229.09 Median $323.59 Typical High $426.58 | Professional | None | $229.09 | $323.59 | $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 $120.23 Median $138.04 Typical High $154.88 | Professional | 52 · Reduced service | $120.23 | $138.04 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $47.86 Median $54.95 Typical High $63.10 | Professional | 53 · Discontinued | $47.86 | $54.95 | $63.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $177.83 Median $204.17 Typical High $234.42 | Professional | 54 · Surgery only | $177.83 | $204.17 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $40.74 Typical High $46.77 | Professional | 55 · Aftercare only | $35.48 | $40.74 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.99 Median $27.54 Typical High $31.62 | Professional | 56 · Pre-op care only | $23.99 | $27.54 | $31.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $190.55 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $165.96 | $190.55 | $218.78 |
Highmark BCBS Setting Facility Modifier 79 · Unrelated procedure after surgery Typical Low $208.93 Median $208.93 Typical High $208.93 | Facility | 79 · Unrelated procedure after surgery | $208.93 | $208.93 | $208.93 |
Where Delaware sits
The same service costs 4.7 times more in Alaska 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· 45th of 51
$302
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.