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 $109.65 Median $147.91 Typical High $7,244.36 | Facility | None | $109.65 | $147.91 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $141.25 Typical High $169.82 | Professional | None | $109.65 | $141.25 | $169.82 |
Cigna Setting Facility Modifier None Typical Low $109.65 Median $173.78 Typical High $588.84 | Facility | None | $109.65 | $173.78 | $588.84 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $125.89 Typical High $190.55 | Professional | None | $97.72 | $125.89 | $190.55 |
United Setting Facility Modifier None Typical Low $416.87 Median $616.60 Typical High $2,398.83 | Facility | None | $416.87 | $616.60 | $2,398.83 |
United Setting Professional Modifier None Typical Low $91.20 Median $123.03 Typical High $186.21 | Professional | None | $91.20 | $123.03 | $186.21 |
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 $54.95 Median $67.61 Typical High $79.43 | Professional | 52 · Reduced service | $54.95 | $67.61 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $26.92 Typical High $31.62 | Professional | 53 · Discontinued | $21.88 | $26.92 | $31.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $102.33 Typical High $117.49 | Professional | 54 · Surgery only | $81.28 | $102.33 | $117.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $20.42 Typical High $23.44 | Professional | 55 · Aftercare only | $16.60 | $20.42 | $23.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $13.49 Typical High $15.85 | Professional | 56 · Pre-op care only | $10.96 | $13.49 | $15.85 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $75.86 Median $95.50 Typical High $109.65 | Professional | 78 · Unplanned return to OR | $75.86 | $95.50 | $109.65 |
Highmark BCBS Setting Professional Modifier 59 · Distinct service Typical Low $147.91 Median $147.91 Typical High $147.91 | Professional | 59 · Distinct service | $147.91 | $147.91 | $147.91 |
Where Delaware sits
The same service costs 4.0 times more in Alaska than in New Jersey. 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· 47th of 51
$126
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.