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 $1,230.27 Median $1,230.27 Typical High $1,412.54 | Facility | None | $1,230.27 | $1,230.27 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $66.07 Median $97.72 Typical High $97.72 | Professional | None | $66.07 | $97.72 | $97.72 |
Cigna Setting Facility Modifier None Typical Low $102.33 Median $102.33 Typical High $147.91 | Facility | None | $102.33 | $102.33 | $147.91 |
Cigna Setting Professional Modifier None Typical Low $489.78 Median $489.78 Typical High $489.78 | Professional | None | $489.78 | $489.78 | $489.78 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $562.34 | Facility | None | $100.00 | $131.83 | $562.34 |
United Setting Professional Modifier None Typical Low $66.07 Median $112.20 Typical High $269.15 | Professional | None | $66.07 | $112.20 | $269.15 |
5 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 $33.11 Median $47.86 Typical High $48.98 | Professional | 52 · Reduced service | $33.11 | $47.86 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $19.50 Typical High $19.50 | Professional | 53 · Discontinued | $13.18 | $19.50 | $19.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $50.12 Median $72.44 Typical High $74.13 | Professional | 54 · Surgery only | $50.12 | $72.44 | $74.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $14.45 Typical High $14.79 | Professional | 55 · Aftercare only | $10.00 | $14.45 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $9.77 Typical High $9.77 | Professional | 56 · Pre-op care only | $6.61 | $9.77 | $9.77 |
Where West Virginia sits
The same service costs 3.4 times more in Alaska than in Virginia. 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.
West Virginia· 36th of 51
$102
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.