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 $120.23 Median $208.93 Typical High $7,244.36 | Facility | None | $120.23 | $208.93 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $123.03 Median $208.93 Typical High $398.11 | Professional | None | $123.03 | $208.93 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $85.11 Typical High $194.98 | Facility | None | $56.23 | $85.11 | $194.98 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $223.87 Typical High $354.81 | Professional | None | $138.04 | $223.87 | $354.81 |
Highmark BCBS Setting Facility Modifier None Typical Low $112.20 Median $354.81 Typical High $371.54 | Facility | None | $112.20 | $354.81 | $371.54 |
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 $109.65 Median $181.97 Typical High $302.00 | Professional | None | $109.65 | $181.97 | $302.00 |
6 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 $61.66 Median $67.61 Typical High $104.71 | Professional | 52 · Reduced service | $61.66 | $67.61 | $104.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $26.92 Typical High $41.69 | Professional | 53 · Discontinued | $24.55 | $26.92 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $100.00 Typical High $158.49 | Professional | 54 · Surgery only | $91.20 | $100.00 | $158.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $19.95 Typical High $31.62 | Professional | 55 · Aftercare only | $18.20 | $19.95 | $31.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $13.49 Typical High $20.89 | Professional | 56 · Pre-op care only | $12.30 | $13.49 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $93.33 Typical High $147.91 | Professional | 78 · Unplanned return to OR | $85.11 | $93.33 | $147.91 |
Where Delaware sits
The same service costs 4.5 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· 30th of 51
$209
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.