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 $1,412.54 Median $1,412.54 Typical High $1,412.54 | Facility | None | $1,412.54 | $1,412.54 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $1,412.54 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,412.54 | $1,445.44 | $1,445.44 |
CareSource Setting Professional Modifier None Typical Low $1,659.59 Median $1,659.59 Typical High $1,659.59 | Professional | None | $1,659.59 | $1,659.59 | $1,659.59 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $2,344.23 | Facility | None | $34.67 | $34.67 | $2,344.23 |
Cigna Setting Professional Modifier None Typical Low $1,348.96 Median $2,187.76 Typical High $12,302.69 | Professional | None | $1,348.96 | $2,187.76 | $12,302.69 |
United Setting Facility Modifier None Typical Low $151.36 Median $660.69 Typical High $870.96 | Facility | None | $151.36 | $660.69 | $870.96 |
United Setting Professional Modifier None Typical Low $1,023.29 Median $1,318.26 Typical High $2,238.72 | Professional | None | $1,023.29 | $1,318.26 | $2,238.72 |
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 $707.95 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $707.95 | $724.44 | $724.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $281.84 Median $288.40 Typical High $288.40 | Professional | 53 · Discontinued | $281.84 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,047.13 Median $1,096.48 Typical High $1,096.48 | Professional | 54 · Surgery only | $1,047.13 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $213.80 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $144.54 Typical High $144.54 | Professional | 56 · Pre-op care only | $141.25 | $144.54 | $144.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $977.24 Median $1,023.29 Typical High $1,023.29 | Professional | 78 · Unplanned return to OR | $977.24 | $1,023.29 | $1,023.29 |
Where West Virginia sits
The same service costs 5.2 times more in Alaska than in Texas. 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· 36th of 51
$1,479
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.