How much rates vary
Facilitymedian $525 · 10th to 90th $282 to $2,042Professionalmedian $1,148 · 10th to 90th $851 to $1,820
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 $1,380.38 Typical High $2,454.71 | Facility | None | $1,071.52 | $1,380.38 | $2,454.71 |
Aetna Setting Professional Modifier None Typical Low $1,023.29 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,023.29 | $1,288.25 | $1,288.25 |
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 $851.14 Median $977.24 Typical High $1,862.09 | Professional | None | $851.14 | $977.24 | $1,862.09 |
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 $512.86 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $512.86 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $204.17 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $204.17 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $954.99 Typical High $954.99 | Professional | 54 · Surgery only | $776.25 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $154.88 Median $190.55 Typical High $190.55 | Professional | 55 · Aftercare only | $154.88 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $102.33 Median $128.82 Typical High $128.82 | Professional | 56 · Pre-op care only | $102.33 | $128.82 | $128.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $891.25 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $724.44 | $891.25 | $891.25 |