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 $104.71 Median $138.04 Typical High $154.88 | Professional | None | $104.71 | $138.04 | $154.88 |
CareSource Setting Professional Modifier None Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | None | $123.03 | $123.03 | $123.03 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $173.78 Typical High $269.15 | Facility | None | $34.67 | $173.78 | $269.15 |
Cigna Setting Professional Modifier None Typical Low $120.23 Median $208.93 Typical High $407.38 | Professional | None | $120.23 | $208.93 | $407.38 |
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 $83.18 Median $123.03 Typical High $223.87 | Professional | None | $83.18 | $123.03 | $223.87 |
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 $52.48 Median $64.57 Typical High $70.79 | Professional | 52 · Reduced service | $52.48 | $64.57 | $70.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $25.70 Typical High $28.18 | Professional | 53 · Discontinued | $21.38 | $25.70 | $28.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $97.72 Typical High $104.71 | Professional | 54 · Surgery only | $79.43 | $97.72 | $104.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $19.50 Typical High $20.89 | Professional | 55 · Aftercare only | $15.85 | $19.50 | $20.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $12.88 Typical High $14.13 | Professional | 56 · Pre-op care only | $10.47 | $12.88 | $14.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $91.20 Typical High $97.72 | Professional | 78 · Unplanned return to OR | $74.13 | $91.20 | $97.72 |
Where West Virginia sits
The same service costs 4.0 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
$141
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.