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 $218.78 Median $263.03 Typical High $338.84 | Professional | None | $218.78 | $263.03 | $338.84 |
CareSource Setting Professional Modifier None Typical Low $251.19 Median $251.19 Typical High $251.19 | Professional | None | $251.19 | $251.19 | $251.19 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $346.74 Typical High $707.95 | Facility | None | $34.67 | $346.74 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $263.03 Median $446.68 Typical High $851.14 | Professional | None | $263.03 | $446.68 | $851.14 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $4,365.16 | Facility | None | $426.58 | $660.69 | $4,365.16 |
United Setting Professional Modifier None Typical Low $177.83 Median $269.15 Typical High $478.63 | Professional | None | $177.83 | $269.15 | $478.63 |
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 $109.65 Median $131.83 Typical High $169.82 | Professional | 52 · Reduced service | $109.65 | $131.83 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $52.48 Typical High $67.61 | Professional | 53 · Discontinued | $43.65 | $52.48 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $165.96 Median $194.98 Typical High $251.19 | Professional | 54 · Surgery only | $165.96 | $194.98 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.11 Median $38.90 Typical High $51.29 | Professional | 55 · Aftercare only | $33.11 | $38.90 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $26.30 Typical High $33.88 | Professional | 56 · Pre-op care only | $21.88 | $26.30 | $33.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $154.88 Median $181.97 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $154.88 | $181.97 | $234.42 |
Where West Virginia sits
The same service costs 3.6 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· 32nd of 51
$331
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.