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 $128.82 Median $147.91 Typical High $549.54 | Professional | None | $128.82 | $147.91 | $549.54 |
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 $34.67 Median $34.67 Typical High $190.55 | Facility | None | $34.67 | $34.67 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $169.82 Median $602.56 Typical High $2,630.27 | Professional | None | $169.82 | $602.56 | $2,630.27 |
United Setting Facility Modifier None Typical Low $457.09 Median $457.09 Typical High $457.09 | Facility | None | $457.09 | $457.09 | $457.09 |
United Setting Professional Modifier None Typical Low $125.89 Median $354.81 Typical High $1,202.26 | Professional | None | $125.89 | $354.81 | $1,202.26 |
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 $63.10 Median $74.13 Typical High $269.15 | Professional | 52 · Reduced service | $63.10 | $74.13 | $269.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $29.51 Typical High $109.65 | Professional | 53 · Discontinued | $25.70 | $29.51 | $109.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $112.20 Typical High $407.38 | Professional | 54 · Surgery only | $95.50 | $112.20 | $407.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $22.39 Typical High $81.28 | Professional | 55 · Aftercare only | $19.05 | $22.39 | $81.28 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $14.79 Typical High $54.95 | Professional | 56 · Pre-op care only | $12.88 | $14.79 | $54.95 |
Where West Virginia sits
The same service costs 4.0 times more in Wisconsin than in Maryland. 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· 39th of 51
$398
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.