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 $120.23 Median $123.03 Typical High $123.03 | Professional | None | $120.23 | $123.03 | $123.03 |
CareSource Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $138.04 | Professional | None | $138.04 | $138.04 | $138.04 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $199.53 Typical High $1,778.28 | Facility | None | $34.67 | $199.53 | $1,778.28 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $186.21 Typical High $346.74 | Professional | None | $117.49 | $186.21 | $346.74 |
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 $93.33 Median $117.49 Typical High $199.53 | Professional | None | $93.33 | $117.49 | $199.53 |
5 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 $60.26 Median $61.66 Typical High $61.66 | Professional | 52 · Reduced service | $60.26 | $61.66 | $61.66 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $24.55 Typical High $24.55 | Professional | 53 · Discontinued | $23.99 | $24.55 | $24.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $93.33 Typical High $93.33 | Professional | 54 · Surgery only | $91.20 | $93.33 | $93.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $18.62 Typical High $18.62 | Professional | 55 · Aftercare only | $18.20 | $18.62 | $18.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $12.30 Typical High $12.30 | Professional | 56 · Pre-op care only | $12.02 | $12.30 | $12.30 |
Where West Virginia sits
The same service costs 6.0 times more in Alaska than in Kentucky. 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· 40th of 51
$135
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.