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 $1,412.54 | Facility | None | $1,412.54 | $1,412.54 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $186.21 Median $218.78 Typical High $295.12 | Professional | None | $186.21 | $218.78 | $295.12 |
CareSource Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $229.09 | Professional | None | $229.09 | $229.09 | $229.09 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $323.59 | Facility | None | $34.67 | $34.67 | $323.59 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $316.23 Typical High $1,096.48 | Professional | None | $204.17 | $316.23 | $1,096.48 |
United Setting Facility Modifier None Typical Low $151.36 Median $436.52 Typical High $2,041.74 | Facility | None | $151.36 | $436.52 | $2,041.74 |
United Setting Professional Modifier None Typical Low $208.93 Median $354.81 Typical High $851.14 | Professional | None | $208.93 | $354.81 | $851.14 |
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 $93.33 Median $109.65 Typical High $147.91 | Professional | 52 · Reduced service | $93.33 | $109.65 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $43.65 Typical High $58.88 | Professional | 53 · Discontinued | $37.15 | $43.65 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $162.18 Typical High $223.87 | Professional | 54 · Surgery only | $141.25 | $162.18 | $223.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $32.36 Typical High $44.67 | Professional | 55 · Aftercare only | $28.18 | $32.36 | $44.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $21.88 Typical High $29.51 | Professional | 56 · Pre-op care only | $18.62 | $21.88 | $29.51 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $131.83 Median $151.36 Typical High $208.93 | Professional | 78 · Unplanned return to OR | $131.83 | $151.36 | $208.93 |
Where West Virginia sits
The same service costs 4.1 times more in Alaska than in Kentucky. 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· 39th of 51
$316
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.