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 $2,344.23 | Facility | None | $1,412.54 | $1,412.54 | $2,344.23 |
Aetna Setting Professional Modifier None Typical Low $269.15 Median $323.59 Typical High $389.05 | Professional | None | $269.15 | $323.59 | $389.05 |
CareSource Setting Professional Modifier None Typical Low $316.23 Median $316.23 Typical High $316.23 | Professional | None | $316.23 | $316.23 | $316.23 |
Cigna Setting Facility Modifier None Typical Low $457.09 Median $741.31 Typical High $4,466.84 | Facility | None | $457.09 | $741.31 | $4,466.84 |
Cigna Setting Professional Modifier None Typical Low $323.59 Median $602.56 Typical High $1,258.93 | Professional | None | $323.59 | $602.56 | $1,258.93 |
United Setting Facility Modifier None Typical Low $1,202.26 Median $1,479.11 Typical High $9,120.11 | Facility | None | $1,202.26 | $1,479.11 | $9,120.11 |
United Setting Professional Modifier None Typical Low $218.78 Median $389.05 Typical High $758.58 | Professional | None | $218.78 | $389.05 | $758.58 |
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 $134.90 Median $162.18 Typical High $194.98 | Professional | 52 · Reduced service | $134.90 | $162.18 | $194.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $53.70 Median $64.57 Typical High $77.62 | Professional | 53 · Discontinued | $53.70 | $64.57 | $77.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $199.53 Median $239.88 Typical High $295.12 | Professional | 54 · Surgery only | $199.53 | $239.88 | $295.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $39.81 Median $47.86 Typical High $58.88 | Professional | 55 · Aftercare only | $39.81 | $47.86 | $58.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.92 Median $32.36 Typical High $38.90 | Professional | 56 · Pre-op care only | $26.92 | $32.36 | $38.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $186.21 Median $223.87 Typical High $275.42 | Professional | 78 · Unplanned return to OR | $186.21 | $223.87 | $275.42 |
Where West Virginia sits
The same service costs 5.9 times more in Alaska than in Utah. 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
$417
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.