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 $190.55 Median $245.47 Typical High $281.84 | Professional | None | $190.55 | $245.47 | $281.84 |
CareSource Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | None | $223.87 | $223.87 | $223.87 |
Cigna Setting Facility Modifier None Typical Low $331.13 Median $537.03 Typical High $1,659.59 | Facility | None | $331.13 | $537.03 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $239.88 Median $416.87 Typical High $1,479.11 | Professional | None | $239.88 | $416.87 | $1,479.11 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $1,513.56 | Facility | None | $100.00 | $131.83 | $1,513.56 |
United Setting Professional Modifier None Typical Low $169.82 Median $281.84 Typical High $660.69 | Professional | None | $169.82 | $281.84 | $660.69 |
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 $95.50 Median $123.03 Typical High $141.25 | Professional | 52 · Reduced service | $95.50 | $123.03 | $141.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $48.98 Typical High $56.23 | Professional | 53 · Discontinued | $38.02 | $48.98 | $56.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $181.97 Typical High $208.93 | Professional | 54 · Surgery only | $141.25 | $181.97 | $208.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $36.31 Typical High $41.69 | Professional | 55 · Aftercare only | $28.18 | $36.31 | $41.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $24.55 Typical High $28.18 | Professional | 56 · Pre-op care only | $19.05 | $24.55 | $28.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $131.83 Median $169.82 Typical High $194.98 | Professional | 78 · Unplanned return to OR | $131.83 | $169.82 | $194.98 |
Where West Virginia sits
The same service costs 3.7 times more in Wisconsin than in Utah. 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· 44th of 51
$288
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.