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 $1,621.81 | Facility | None | $1,412.54 | $1,412.54 | $1,621.81 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $151.36 Typical High $263.03 | Professional | None | $131.83 | $151.36 | $263.03 |
CareSource Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | None | $151.36 | $151.36 | $151.36 |
Cigna Setting Facility Modifier None Typical Low $208.93 Median $537.03 Typical High $1,659.59 | Facility | None | $208.93 | $537.03 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $162.18 Median $389.05 Typical High $1,318.26 | Professional | None | $162.18 | $389.05 | $1,318.26 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $1,096.48 | Facility | None | $100.00 | $131.83 | $1,096.48 |
United Setting Professional Modifier None Typical Low $114.82 Median $223.87 Typical High $562.34 | Professional | None | $114.82 | $223.87 | $562.34 |
5 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 $64.57 Median $75.86 Typical High $131.83 | Professional | 52 · Reduced service | $64.57 | $75.86 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $30.20 Typical High $52.48 | Professional | 53 · Discontinued | $26.30 | $30.20 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $114.82 Typical High $199.53 | Professional | 54 · Surgery only | $97.72 | $114.82 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $22.91 Typical High $39.81 | Professional | 55 · Aftercare only | $19.50 | $22.91 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $15.14 Typical High $26.30 | Professional | 56 · Pre-op care only | $13.18 | $15.14 | $26.30 |
Where West Virginia sits
The same service costs 3.2 times more in Wisconsin 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· 41st of 51
$257
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.