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 $467.74 Median $467.74 Typical High $501.19 | Professional | None | $467.74 | $467.74 | $501.19 |
CareSource Setting Professional Modifier None Typical Low $562.34 Median $562.34 Typical High $562.34 | Professional | None | $562.34 | $562.34 | $562.34 |
Cigna Setting Facility Modifier None Typical Low $371.54 Median $398.11 Typical High $1,318.26 | Facility | None | $371.54 | $398.11 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $512.86 Median $776.25 Typical High $1,380.38 | Professional | None | $512.86 | $776.25 | $1,380.38 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $691.83 | Facility | None | $100.00 | $131.83 | $691.83 |
United Setting Professional Modifier None Typical Low $354.81 Median $524.81 Typical High $1,023.29 | Professional | None | $354.81 | $524.81 | $1,023.29 |
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 $234.42 Median $251.19 Typical High $251.19 | Professional | 52 · Reduced service | $234.42 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $95.50 Median $100.00 Typical High $100.00 | Professional | 53 · Discontinued | $95.50 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $354.81 Median $380.19 Typical High $380.19 | Professional | 54 · Surgery only | $354.81 | $380.19 | $380.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $75.86 Typical High $75.86 | Professional | 55 · Aftercare only | $70.79 | $75.86 | $75.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $50.12 Typical High $50.12 | Professional | 56 · Pre-op care only | $46.77 | $50.12 | $50.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $331.13 Median $354.81 Typical High $354.81 | Professional | 78 · Unplanned return to OR | $331.13 | $354.81 | $354.81 |
Where West Virginia sits
The same service costs 5.8 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· 30th of 51
$603
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.