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 $3,630.78 | Facility | None | $1,412.54 | $1,412.54 | $3,630.78 |
Aetna Setting Professional Modifier None Typical Low $707.95 Median $912.01 Typical High $1,548.82 | Professional | None | $707.95 | $912.01 | $1,548.82 |
CareSource Setting Professional Modifier None Typical Low $831.76 Median $831.76 Typical High $831.76 | Professional | None | $831.76 | $831.76 | $831.76 |
Cigna Setting Facility Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $8,128.31 | Facility | None | $1,174.90 | $1,174.90 | $8,128.31 |
Cigna Setting Professional Modifier None Typical Low $1,023.29 Median $2,290.87 Typical High $4,897.79 | Professional | None | $1,023.29 | $2,290.87 | $4,897.79 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,162.28 Typical High $16,595.87 | Facility | None | $1,698.24 | $3,162.28 | $16,595.87 |
United Setting Professional Modifier None Typical Low $602.56 Median $1,258.93 Typical High $2,630.27 | Professional | None | $602.56 | $1,258.93 | $2,630.27 |
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 $354.81 Median $457.09 Typical High $776.25 | Professional | 52 · Reduced service | $354.81 | $457.09 | $776.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $141.25 Median $181.97 Typical High $309.03 | Professional | 53 · Discontinued | $141.25 | $181.97 | $309.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $537.03 Median $676.08 Typical High $1,174.90 | Professional | 54 · Surgery only | $537.03 | $676.08 | $1,174.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $107.15 Median $138.04 Typical High $234.42 | Professional | 55 · Aftercare only | $107.15 | $138.04 | $234.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $70.79 Median $91.20 Typical High $154.88 | Professional | 56 · Pre-op care only | $70.79 | $91.20 | $154.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $501.19 Median $630.96 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $501.19 | $630.96 | $1,096.48 |
Where West Virginia sits
The same service costs 4.9 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
$1,413
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.