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 $102.33 Median $154.88 Typical High $7,244.36 | Facility | None | $102.33 | $154.88 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $102.33 Median $134.90 Typical High $162.18 | Professional | None | $102.33 | $134.90 | $162.18 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $154.88 Typical High $2,137.96 | Facility | None | $100.00 | $154.88 | $2,137.96 |
Cigna Setting Professional Modifier None Typical Low $112.20 Median $147.91 Typical High $229.09 | Professional | None | $112.20 | $147.91 | $229.09 |
United Setting Facility Modifier None Typical Low $912.01 Median $1,258.93 Typical High $2,570.40 | Facility | None | $912.01 | $1,258.93 | $2,570.40 |
United Setting Professional Modifier None Typical Low $107.15 Median $154.88 Typical High $234.42 | Professional | None | $107.15 | $154.88 | $234.42 |
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 $51.29 Median $60.26 Typical High $77.62 | Professional | 52 · Reduced service | $51.29 | $60.26 | $77.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $23.99 Typical High $30.90 | Professional | 53 · Discontinued | $20.42 | $23.99 | $30.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $91.20 Typical High $117.49 | Professional | 54 · Surgery only | $75.86 | $91.20 | $117.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $18.20 Typical High $23.44 | Professional | 55 · Aftercare only | $15.14 | $18.20 | $23.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $12.02 Typical High $15.49 | Professional | 56 · Pre-op care only | $10.23 | $12.02 | $15.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $70.79 Median $85.11 Typical High $109.65 | Professional | 78 · Unplanned return to OR | $70.79 | $85.11 | $109.65 |
Where Delaware sits
The same service costs 3.6 times more in Wisconsin than in Texas. 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· 42nd of 51
$155
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.