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 $1,230.27 Median $1,230.27 Typical High $1,412.54 | Facility | None | $1,230.27 | $1,230.27 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $436.52 Median $436.52 Typical High $436.52 | Professional | None | $436.52 | $436.52 | $436.52 |
CareSource Setting Professional Modifier None Typical Low $489.78 Median $489.78 Typical High $489.78 | Professional | None | $489.78 | $489.78 | $489.78 |
Cigna Setting Facility Modifier None Typical Low $398.11 Median $724.44 Typical High $3,981.07 | Facility | None | $398.11 | $724.44 | $3,981.07 |
Cigna Setting Professional Modifier None Typical Low $436.52 Median $645.65 Typical High $2,089.30 | Professional | None | $436.52 | $645.65 | $2,089.30 |
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 $316.23 Median $398.11 Typical High $758.58 | Professional | None | $316.23 | $398.11 | $758.58 |
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 $213.80 Median $213.80 Typical High $218.78 | Professional | 52 · Reduced service | $213.80 | $213.80 | $218.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $87.10 Median $87.10 Typical High $87.10 | Professional | 53 · Discontinued | $87.10 | $87.10 | $87.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $323.59 Median $323.59 Typical High $323.59 | Professional | 54 · Surgery only | $323.59 | $323.59 | $323.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $64.57 Median $64.57 Typical High $66.07 | Professional | 55 · Aftercare only | $64.57 | $64.57 | $66.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $43.65 Typical High $43.65 | Professional | 56 · Pre-op care only | $43.65 | $43.65 | $43.65 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $302.00 | $302.00 | $302.00 |
Where West Virginia sits
The same service costs 6.2 times more in Alaska than in Texas. 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· 33rd of 51
$490
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.