How much rates vary
Facilitymedian $525 · 10th to 90th $282 to $2,455Professionalmedian $3,548 · 10th to 90th $2,512 to $6,026
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $1,071.52 Median $1,862.09 Typical High $4,265.80 | Facility | None | $1,071.52 | $1,862.09 | $4,265.80 |
Aetna Setting Professional Modifier None Typical Low $3,090.30 Median $4,265.80 Typical High $4,265.80 | Professional | None | $3,090.30 | $4,265.80 | $4,265.80 |
United Setting Facility Modifier None Typical Low $281.84 Median $457.09 Typical High $1,995.26 | Facility | None | $281.84 | $457.09 | $1,995.26 |
United Setting Professional Modifier None Typical Low $2,511.89 Median $3,235.94 Typical High $6,165.95 | Professional | None | $2,511.89 | $3,235.94 | $6,165.95 |
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 $1,778.28 Median $2,137.96 Typical High $2,137.96 | Professional | 52 · Reduced service | $1,778.28 | $2,137.96 | $2,137.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $707.95 Median $851.14 Typical High $851.14 | Professional | 53 · Discontinued | $707.95 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,630.27 Median $3,162.28 Typical High $3,162.28 | Professional | 54 · Surgery only | $2,630.27 | $3,162.28 | $3,162.28 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $524.81 Median $630.96 Typical High $630.96 | Professional | 55 · Aftercare only | $524.81 | $630.96 | $630.96 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $354.81 Median $426.58 Typical High $426.58 | Professional | 56 · Pre-op care only | $354.81 | $426.58 | $426.58 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,454.71 Median $2,951.21 Typical High $2,951.21 | Professional | 78 · Unplanned return to OR | $2,454.71 | $2,951.21 | $2,951.21 |