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 $1,412.54 Median $1,412.54 Typical High $1,621.81 | Facility | None | $1,412.54 | $1,412.54 | $1,621.81 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $234.42 Typical High $269.15 | Professional | None | $173.78 | $234.42 | $269.15 |
CareSource Setting Professional Modifier None Typical Low $213.80 Median $213.80 Typical High $213.80 | Professional | None | $213.80 | $213.80 | $213.80 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $309.03 Typical High $512.86 | Facility | None | $34.67 | $309.03 | $512.86 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $407.38 Typical High $741.31 | Professional | None | $208.93 | $407.38 | $741.31 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $5,754.40 | Facility | None | $426.58 | $660.69 | $5,754.40 |
United Setting Professional Modifier None Typical Low $177.83 Median $269.15 Typical High $588.84 | Professional | None | $177.83 | $269.15 | $588.84 |
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 $87.10 Median $89.13 Typical High $134.90 | Professional | 52 · Reduced service | $87.10 | $89.13 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $35.48 Typical High $53.70 | Professional | 53 · Discontinued | $34.67 | $35.48 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $131.83 Typical High $199.53 | Professional | 54 · Surgery only | $128.82 | $131.83 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $26.92 Typical High $39.81 | Professional | 55 · Aftercare only | $25.70 | $26.92 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $17.78 Typical High $26.92 | Professional | 56 · Pre-op care only | $17.38 | $17.78 | $26.92 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $123.03 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $120.23 | $123.03 | $186.21 |
Where West Virginia sits
The same service costs 3.5 times more in Alaska 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.
West Virginia· 35th of 51
$275
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.