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 $165.96 Median $199.53 Typical High $257.04 | Professional | None | $165.96 | $199.53 | $257.04 |
CareSource Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $199.53 | Professional | None | $199.53 | $199.53 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $275.42 Median $398.11 Typical High $1,995.26 | Facility | None | $275.42 | $398.11 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $389.05 Typical High $707.95 | Professional | None | $218.78 | $389.05 | $707.95 |
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 $138.04 Median $223.87 Typical High $407.38 | Professional | None | $138.04 | $223.87 | $407.38 |
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 $83.18 Median $100.00 Typical High $128.82 | Professional | 52 · Reduced service | $83.18 | $100.00 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $39.81 Typical High $51.29 | Professional | 53 · Discontinued | $33.88 | $39.81 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $125.89 Median $151.36 Typical High $194.98 | Professional | 54 · Surgery only | $125.89 | $151.36 | $194.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.12 Median $30.20 Typical High $38.90 | Professional | 55 · Aftercare only | $25.12 | $30.20 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.60 Median $19.95 Typical High $25.70 | Professional | 56 · Pre-op care only | $16.60 | $19.95 | $25.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $117.49 Median $141.25 Typical High $181.97 | Professional | 78 · Unplanned return to OR | $117.49 | $141.25 | $181.97 |
Where West Virginia sits
The same service costs 4.1 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· 36th of 51
$263
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.