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 $151.36 Median $177.83 Typical High $251.19 | Professional | None | $151.36 | $177.83 | $251.19 |
CareSource Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | None | $173.78 | $173.78 | $173.78 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $251.19 Typical High $1,995.26 | Facility | None | $34.67 | $251.19 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $380.19 Typical High $691.83 | Professional | None | $208.93 | $380.19 | $691.83 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $4,570.88 | Facility | None | $426.58 | $660.69 | $4,570.88 |
United Setting Professional Modifier None Typical Low $123.03 Median $213.80 Typical High $398.11 | Professional | None | $123.03 | $213.80 | $398.11 |
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 $75.86 Median $89.13 Typical High $125.89 | Professional | 52 · Reduced service | $75.86 | $89.13 | $125.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $35.48 Typical High $50.12 | Professional | 53 · Discontinued | $30.20 | $35.48 | $50.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $134.90 Typical High $190.55 | Professional | 54 · Surgery only | $112.20 | $134.90 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $26.92 Typical High $38.02 | Professional | 55 · Aftercare only | $22.39 | $26.92 | $38.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $17.78 Typical High $25.12 | Professional | 56 · Pre-op care only | $15.14 | $17.78 | $25.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $125.89 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $104.71 | $125.89 | $177.83 |
Where West Virginia sits
The same service costs 4.5 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
$240
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.