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 $91.20 Median $134.90 Typical High $204.17 | Professional | None | $91.20 | $134.90 | $204.17 |
CareSource Setting Professional Modifier None Typical Low $104.71 Median $104.71 Typical High $104.71 | Professional | None | $104.71 | $104.71 | $104.71 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $398.11 Typical High $1,778.28 | Facility | None | $151.36 | $398.11 | $1,778.28 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $263.03 Typical High $588.84 | Professional | None | $114.82 | $263.03 | $588.84 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $3,311.31 | Facility | None | $426.58 | $660.69 | $3,311.31 |
United Setting Professional Modifier None Typical Low $74.13 Median $144.54 Typical High $288.40 | Professional | None | $74.13 | $144.54 | $288.40 |
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 $44.67 Median $67.61 Typical High $102.33 | Professional | 52 · Reduced service | $44.67 | $67.61 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $26.92 Typical High $40.74 | Professional | 53 · Discontinued | $18.20 | $26.92 | $40.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $100.00 Typical High $154.88 | Professional | 54 · Surgery only | $67.61 | $100.00 | $154.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $19.95 Typical High $30.90 | Professional | 55 · Aftercare only | $13.49 | $19.95 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $13.49 Typical High $20.42 | Professional | 56 · Pre-op care only | $9.12 | $13.49 | $20.42 |
Where West Virginia sits
The same service costs 4.2 times more in Alaska 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· 41st of 51
$170
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.