How much rates vary
Facilitymedian $525 · 10th to 90th $282 to $2,455Professionalmedian $2,754 · 10th to 90th $2,042 to $4,467
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 $3,162.28 | Facility | None | $1,071.52 | $1,862.09 | $3,162.28 |
Aetna Setting Professional Modifier None Typical Low $2,570.40 Median $3,162.28 Typical High $3,162.28 | Professional | None | $2,570.40 | $3,162.28 | $3,162.28 |
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 $2,041.74 Median $2,398.83 Typical High $4,677.35 | Professional | None | $2,041.74 | $2,398.83 | $4,677.35 |
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 $1,288.25 Median $1,584.89 Typical High $1,584.89 | Professional | 52 · Reduced service | $1,288.25 | $1,584.89 | $1,584.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $512.86 Median $630.96 Typical High $630.96 | Professional | 53 · Discontinued | $512.86 | $630.96 | $630.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,949.84 Median $2,398.83 Typical High $2,398.83 | Professional | 54 · Surgery only | $1,949.84 | $2,398.83 | $2,398.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $389.05 Median $478.63 Typical High $478.63 | Professional | 55 · Aftercare only | $389.05 | $478.63 | $478.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $257.04 Median $316.23 Typical High $316.23 | Professional | 56 · Pre-op care only | $257.04 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,819.70 Median $2,238.72 Typical High $2,238.72 | Professional | 78 · Unplanned return to OR | $1,819.70 | $2,238.72 | $2,238.72 |