How much rates vary
Facilitymedian $525 · 10th to 90th $282 to $2,042Professionalmedian $1,318 · 10th to 90th $955 to $2,239
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 $1,584.89 Typical High $2,454.71 | Facility | None | $1,071.52 | $1,584.89 | $2,454.71 |
Aetna Setting Professional Modifier None Typical Low $1,230.27 Median $1,584.89 Typical High $1,584.89 | Professional | None | $1,230.27 | $1,584.89 | $1,584.89 |
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 $954.99 Median $1,174.90 Typical High $2,344.23 | Professional | None | $954.99 | $1,174.90 | $2,344.23 |
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 $616.60 Median $794.33 Typical High $794.33 | Professional | 52 · Reduced service | $616.60 | $794.33 | $794.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $316.23 Typical High $316.23 | Professional | 53 · Discontinued | $245.47 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $1,174.90 Typical High $1,174.90 | Professional | 54 · Surgery only | $933.25 | $1,174.90 | $1,174.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $239.88 Typical High $239.88 | Professional | 55 · Aftercare only | $186.21 | $239.88 | $239.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $158.49 Typical High $158.49 | Professional | 56 · Pre-op care only | $123.03 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $1,096.48 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $870.96 | $1,096.48 | $1,096.48 |