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 $245.47 | Professional | None | $151.36 | $177.83 | $245.47 |
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 $245.47 Typical High $501.19 | Facility | None | $34.67 | $245.47 | $501.19 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $363.08 Typical High $676.08 | Professional | None | $208.93 | $363.08 | $676.08 |
United Setting Facility Modifier None Typical Low $151.36 Median $436.52 Typical High $4,570.88 | Facility | None | $151.36 | $436.52 | $4,570.88 |
United Setting Professional Modifier None Typical Low $123.03 Median $204.17 Typical High $398.11 | Professional | None | $123.03 | $204.17 | $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 $123.03 | Professional | 52 · Reduced service | $75.86 | $89.13 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $35.48 Typical High $48.98 | Professional | 53 · Discontinued | $30.20 | $35.48 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $134.90 Typical High $181.97 | Professional | 54 · Surgery only | $112.20 | $134.90 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $26.92 Typical High $36.31 | Professional | 55 · Aftercare only | $22.39 | $26.92 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $17.78 Typical High $24.55 | Professional | 56 · Pre-op care only | $15.14 | $17.78 | $24.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $125.89 Typical High $169.82 | Professional | 78 · Unplanned return to OR | $104.71 | $125.89 | $169.82 |
Where West Virginia sits
The same service costs 4.4 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· 38th of 51
$234
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.