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 $102.33 Median $117.49 Typical High $177.83 | Professional | None | $102.33 | $117.49 | $177.83 |
CareSource Setting Professional Modifier None Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | None | $123.03 | $123.03 | $123.03 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $173.78 Typical High $354.81 | Facility | None | $34.67 | $173.78 | $354.81 |
Cigna Setting Professional Modifier None Typical Low $125.89 Median $263.03 Typical High $912.01 | Professional | None | $125.89 | $263.03 | $912.01 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $660.69 | Facility | None | $100.00 | $131.83 | $660.69 |
United Setting Professional Modifier None Typical Low $85.11 Median $154.88 Typical High $363.08 | Professional | None | $85.11 | $154.88 | $363.08 |
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 $51.29 Median $58.88 Typical High $89.13 | Professional | 52 · Reduced service | $51.29 | $58.88 | $89.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $23.44 Typical High $35.48 | Professional | 53 · Discontinued | $20.42 | $23.44 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $89.13 Typical High $134.90 | Professional | 54 · Surgery only | $77.62 | $89.13 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $17.78 Typical High $26.92 | Professional | 55 · Aftercare only | $15.49 | $17.78 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $11.75 Typical High $17.78 | Professional | 56 · Pre-op care only | $10.23 | $11.75 | $17.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $72.44 Median $83.18 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $72.44 | $83.18 | $125.89 |
Where West Virginia sits
The same service costs 4.5 times more in Alaska than in Kentucky. 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· 42nd of 51
$170
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.