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 $1,412.54 | Facility | None | $1,412.54 | $1,412.54 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $107.15 Median $131.83 Typical High $181.97 | Professional | None | $107.15 | $131.83 | $181.97 |
CareSource Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $128.82 | Professional | None | $128.82 | $128.82 | $128.82 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $199.53 | Facility | None | $34.67 | $34.67 | $199.53 |
Cigna Setting Professional Modifier None Typical Low $151.36 Median $269.15 Typical High $1,000.00 | Professional | None | $151.36 | $269.15 | $1,000.00 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $2,511.89 | Facility | None | $426.58 | $660.69 | $2,511.89 |
United Setting Professional Modifier None Typical Low $97.72 Median $177.83 Typical High $416.87 | Professional | None | $97.72 | $177.83 | $416.87 |
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 $53.70 Median $66.07 Typical High $91.20 | Professional | 52 · Reduced service | $53.70 | $66.07 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $26.30 Typical High $36.31 | Professional | 53 · Discontinued | $21.38 | $26.30 | $36.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $97.72 Typical High $134.90 | Professional | 54 · Surgery only | $79.43 | $97.72 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $19.95 Typical High $26.92 | Professional | 55 · Aftercare only | $16.22 | $19.95 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.72 Median $13.18 Typical High $18.20 | Professional | 56 · Pre-op care only | $10.72 | $13.18 | $18.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $91.20 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $74.13 | $91.20 | $125.89 |
Where West Virginia sits
The same service costs 3.8 times more in Wisconsin than in Hawaii. 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· 43rd of 51
$191
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.