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 $407.38 Median $407.38 Typical High $407.38 | Professional | None | $407.38 | $407.38 | $407.38 |
CareSource Setting Professional Modifier None Typical Low $467.74 Median $467.74 Typical High $467.74 | Professional | None | $467.74 | $467.74 | $467.74 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $354.81 Typical High $630.96 | Facility | None | $34.67 | $354.81 | $630.96 |
Cigna Setting Professional Modifier None Typical Low $407.38 Median $616.60 Typical High $2,238.72 | Professional | None | $407.38 | $616.60 | $2,238.72 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $660.69 | Facility | None | $100.00 | $131.83 | $660.69 |
United Setting Professional Modifier None Typical Low $302.00 Median $389.05 Typical High $660.69 | Professional | None | $302.00 | $389.05 | $660.69 |
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 $204.17 Median $204.17 Typical High $204.17 | Professional | 52 · Reduced service | $204.17 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $81.28 Typical High $81.28 | Professional | 53 · Discontinued | $81.28 | $81.28 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | 54 · Surgery only | $302.00 | $302.00 | $302.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $60.26 Typical High $61.66 | Professional | 55 · Aftercare only | $60.26 | $60.26 | $61.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $40.74 Typical High $40.74 | Professional | 56 · Pre-op care only | $40.74 | $40.74 | $40.74 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | 78 · Unplanned return to OR | $281.84 | $281.84 | $281.84 |
Where West Virginia sits
The same service costs 4.2 times more in Wyoming than in Utah. 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· 35th of 51
$447
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.