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 $141.25 Median $169.82 Typical High $169.82 | Professional | None | $141.25 | $169.82 | $169.82 |
CareSource Setting Professional Modifier None Typical Low $169.82 Median $169.82 Typical High $169.82 | Professional | None | $169.82 | $169.82 | $169.82 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $263.03 Typical High $363.08 | Facility | None | $34.67 | $263.03 | $363.08 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $263.03 Typical High $467.74 | Professional | None | $173.78 | $263.03 | $467.74 |
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 $114.82 Median $173.78 Typical High $331.13 | Professional | None | $114.82 | $173.78 | $331.13 |
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 $70.79 Median $83.18 Typical High $85.11 | Professional | 52 · Reduced service | $70.79 | $83.18 | $85.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $33.88 Typical High $33.88 | Professional | 53 · Discontinued | $28.18 | $33.88 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $125.89 Typical High $125.89 | Professional | 54 · Surgery only | $107.15 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $25.12 Typical High $25.12 | Professional | 55 · Aftercare only | $21.38 | $25.12 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $16.60 Typical High $16.98 | Professional | 56 · Pre-op care only | $14.13 | $16.60 | $16.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $117.49 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $100.00 | $117.49 | $117.49 |
Where West Virginia sits
The same service costs 4.6 times more in Alaska than in Florida. 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
$204
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.