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 $85.11 Median $131.83 Typical High $323.59 | Professional | None | $85.11 | $131.83 | $323.59 |
CareSource Setting Professional Modifier None Typical Low $100.00 Median $100.00 Typical High $100.00 | Professional | None | $100.00 | $100.00 | $100.00 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $144.54 Typical High $371.54 | Facility | None | $34.67 | $144.54 | $371.54 |
Cigna Setting Professional Modifier None Typical Low $109.65 Median $295.12 Typical High $676.08 | Professional | None | $109.65 | $295.12 | $676.08 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $691.83 | Facility | None | $100.00 | $131.83 | $691.83 |
United Setting Professional Modifier None Typical Low $69.18 Median $223.87 Typical High $512.86 | Professional | None | $69.18 | $223.87 | $512.86 |
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 $42.66 Median $61.66 Typical High $162.18 | Professional | 52 · Reduced service | $42.66 | $61.66 | $162.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $24.55 Typical High $66.07 | Professional | 53 · Discontinued | $16.98 | $24.55 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $93.33 Typical High $245.47 | Professional | 54 · Surgery only | $63.10 | $93.33 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $18.62 Typical High $48.98 | Professional | 55 · Aftercare only | $12.88 | $18.62 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $12.30 Typical High $32.36 | Professional | 56 · Pre-op care only | $8.51 | $12.30 | $32.36 |
Where West Virginia sits
The same service costs 4.8 times more in Wisconsin than in Washington, DC. 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
$240
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.