How much rates vary
Facilitymedian $525 · 10th to 90th $282 to $2,455Professionalmedian $5,754 · 10th to 90th $3,548 to $9,772
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 $5,888.44 | Facility | None | $1,071.52 | $1,862.09 | $5,888.44 |
Aetna Setting Professional Modifier None Typical Low $4,897.79 Median $5,888.44 Typical High $5,888.44 | Professional | None | $4,897.79 | $5,888.44 | $5,888.44 |
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 $3,311.31 Median $4,897.79 Typical High $10,000.00 | Professional | None | $3,311.31 | $4,897.79 | $10,000.00 |
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 $2,454.71 Median $2,951.21 Typical High $2,951.21 | Professional | 52 · Reduced service | $2,454.71 | $2,951.21 | $2,951.21 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $977.24 Median $1,174.90 Typical High $1,174.90 | Professional | 53 · Discontinued | $977.24 | $1,174.90 | $1,174.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3,715.35 Median $4,365.16 Typical High $4,365.16 | Professional | 54 · Surgery only | $3,715.35 | $4,365.16 | $4,365.16 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $741.31 Median $870.96 Typical High $870.96 | Professional | 55 · Aftercare only | $741.31 | $870.96 | $870.96 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $489.78 Median $588.84 Typical High $588.84 | Professional | 56 · Pre-op care only | $489.78 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,467.37 Median $4,073.80 Typical High $4,073.80 | Professional | 78 · Unplanned return to OR | $3,467.37 | $4,073.80 | $4,073.80 |