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 $75.86 Median $93.33 Typical High $239.88 | Professional | None | $75.86 | $93.33 | $239.88 |
CareSource Setting Professional Modifier None Typical Low $85.11 Median $85.11 Typical High $85.11 | Professional | None | $85.11 | $85.11 | $85.11 |
Cigna Setting Facility Modifier None Typical Low $120.23 Median $120.23 Typical High $120.23 | Facility | None | $120.23 | $120.23 | $120.23 |
Cigna Setting Professional Modifier None Typical Low $95.50 Median $239.88 Typical High $707.95 | Professional | None | $95.50 | $239.88 | $707.95 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $457.09 | Facility | None | $100.00 | $131.83 | $457.09 |
United Setting Professional Modifier None Typical Low $70.79 Median $223.87 Typical High $660.69 | Professional | None | $70.79 | $223.87 | $660.69 |
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 $38.02 Median $46.77 Typical High $120.23 | Professional | 52 · Reduced service | $38.02 | $46.77 | $120.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.14 Median $18.62 Typical High $47.86 | Professional | 53 · Discontinued | $15.14 | $18.62 | $47.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $70.79 Typical High $177.83 | Professional | 54 · Surgery only | $57.54 | $70.79 | $177.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $14.13 Typical High $35.48 | Professional | 55 · Aftercare only | $11.48 | $14.13 | $35.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $9.33 Typical High $23.99 | Professional | 56 · Pre-op care only | $7.59 | $9.33 | $23.99 |
Where West Virginia sits
The same service costs 4.5 times more in Oklahoma than in Nebraska. 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· 38th of 51
$224
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.