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 $257.04 Median $316.23 Typical High $346.74 | Professional | None | $257.04 | $316.23 | $346.74 |
CareSource Setting Professional Modifier None Typical Low $295.12 Median $295.12 Typical High $295.12 | Professional | None | $295.12 | $295.12 | $295.12 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $537.03 Typical High $3,981.07 | Facility | None | $426.58 | $537.03 | $3,981.07 |
Cigna Setting Professional Modifier None Typical Low $295.12 Median $501.19 Typical High $1,000.00 | Professional | None | $295.12 | $501.19 | $1,000.00 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $9,332.54 | Facility | None | $426.58 | $660.69 | $9,332.54 |
United Setting Professional Modifier None Typical Low $208.93 Median $302.00 Typical High $549.54 | Professional | None | $208.93 | $302.00 | $549.54 |
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 $128.82 Median $158.49 Typical High $173.78 | Professional | 52 · Reduced service | $128.82 | $158.49 | $173.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $51.29 Median $63.10 Typical High $69.18 | Professional | 53 · Discontinued | $51.29 | $63.10 | $69.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $234.42 Typical High $263.03 | Professional | 54 · Surgery only | $190.55 | $234.42 | $263.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.90 Median $47.86 Typical High $52.48 | Professional | 55 · Aftercare only | $38.90 | $47.86 | $52.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $31.62 Typical High $34.67 | Professional | 56 · Pre-op care only | $25.70 | $31.62 | $34.67 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $218.78 Typical High $245.47 | Professional | 78 · Unplanned return to OR | $177.83 | $218.78 | $245.47 |
Where West Virginia sits
The same service costs 4.1 times more in Alaska than in New Jersey. 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· 37th of 51
$347
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.