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 $251.19 Median $389.05 Typical High $7,244.36 | Facility | None | $251.19 | $389.05 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $251.19 Median $346.74 Typical High $398.11 | Professional | None | $251.19 | $346.74 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $263.03 Median $407.38 Typical High $2,137.96 | Facility | None | $263.03 | $407.38 | $2,137.96 |
Cigna Setting Professional Modifier None Typical Low $257.04 Median $346.74 Typical High $549.54 | Professional | None | $257.04 | $346.74 | $549.54 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,995.26 Median $1,995.26 Typical High $1,995.26 | Facility | None | $1,995.26 | $1,995.26 | $1,995.26 |
United Setting Facility Modifier None Typical Low $912.01 Median $1,258.93 Typical High $2,570.40 | Facility | None | $912.01 | $1,258.93 | $2,570.40 |
United Setting Professional Modifier None Typical Low $213.80 Median $316.23 Typical High $512.86 | Professional | None | $213.80 | $316.23 | $512.86 |
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 $123.03 Median $138.04 Typical High $190.55 | Professional | 52 · Reduced service | $123.03 | $138.04 | $190.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $48.98 Median $54.95 Typical High $77.62 | Professional | 53 · Discontinued | $48.98 | $54.95 | $77.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $181.97 Median $208.93 Typical High $288.40 | Professional | 54 · Surgery only | $181.97 | $208.93 | $288.40 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $36.31 Median $41.69 Typical High $57.54 | Professional | 55 · Aftercare only | $36.31 | $41.69 | $57.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $24.55 Median $27.54 Typical High $38.90 | Professional | 56 · Pre-op care only | $24.55 | $27.54 | $38.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $169.82 Median $194.98 Typical High $269.15 | Professional | 78 · Unplanned return to OR | $169.82 | $194.98 | $269.15 |
Highmark BCBS Setting Professional Modifier 58 · Staged procedure + 59 · Distinct service + 79 · Unrelated procedure after surgery Typical Low $380.19 Median $380.19 Typical High $380.19 | Professional | 58 · Staged procedure + 59 · Distinct service + 79 · Unrelated procedure after surgery | $380.19 | $380.19 | $380.19 |
Where Delaware sits
The same service costs 4.3 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· 42nd of 51
$331
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.