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 $125.89 Median $147.91 Typical High $190.55 | Professional | None | $125.89 | $147.91 | $190.55 |
CareSource Setting Professional Modifier None Typical Low $154.88 Median $154.88 Typical High $154.88 | Professional | None | $154.88 | $154.88 | $154.88 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $199.53 Typical High $354.81 | Facility | None | $34.67 | $199.53 | $354.81 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $204.17 Typical High $537.03 | Professional | None | $138.04 | $204.17 | $537.03 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $1,148.15 | Facility | None | $100.00 | $131.83 | $1,148.15 |
United Setting Professional Modifier None Typical Low $120.23 Median $190.55 Typical High $436.52 | Professional | None | $120.23 | $190.55 | $436.52 |
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 $63.10 Median $69.18 Typical High $95.50 | Professional | 52 · Reduced service | $63.10 | $69.18 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $27.54 Typical High $38.02 | Professional | 53 · Discontinued | $25.70 | $27.54 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $102.33 Typical High $144.54 | Professional | 54 · Surgery only | $95.50 | $102.33 | $144.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $20.42 Typical High $28.84 | Professional | 55 · Aftercare only | $19.05 | $20.42 | $28.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $13.80 Typical High $19.05 | Professional | 56 · Pre-op care only | $12.59 | $13.80 | $19.05 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $89.13 Median $95.50 Typical High $134.90 | Professional | 78 · Unplanned return to OR | $89.13 | $95.50 | $134.90 |
Where West Virginia sits
The same service costs 3.5 times more in Alaska than in Maryland. 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
$191
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.