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 $123.03 Median $144.54 Typical High $147.91 | Professional | None | $123.03 | $144.54 | $147.91 |
CareSource Setting Professional Modifier None Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | None | $141.25 | $141.25 | $141.25 |
Cigna Setting Facility Modifier None Typical Low $208.93 Median $398.11 Typical High $1,318.26 | Facility | None | $208.93 | $398.11 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $223.87 Typical High $416.87 | Professional | None | $138.04 | $223.87 | $416.87 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $776.25 | Facility | None | $100.00 | $131.83 | $776.25 |
United Setting Professional Modifier None Typical Low $102.33 Median $154.88 Typical High $323.59 | Professional | None | $102.33 | $154.88 | $323.59 |
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 $61.66 Median $72.44 Typical High $72.44 | Professional | 52 · Reduced service | $61.66 | $72.44 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $28.84 Typical High $28.84 | Professional | 53 · Discontinued | $24.55 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $107.15 Typical High $107.15 | Professional | 54 · Surgery only | $91.20 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $21.38 Typical High $21.38 | Professional | 55 · Aftercare only | $18.20 | $21.38 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $14.45 Typical High $14.45 | Professional | 56 · Pre-op care only | $12.30 | $14.45 | $14.45 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $100.00 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $85.11 | $100.00 | $100.00 |
Where West Virginia sits
The same service costs 3.8 times more in Alaska than in Delaware. 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
$178
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.