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 $4,168.69 Median $4,365.16 Typical High $4,365.16 | Professional | None | $4,168.69 | $4,365.16 | $4,365.16 |
CareSource Setting Professional Modifier None Typical Low $5,011.87 Median $5,011.87 Typical High $5,011.87 | Professional | None | $5,011.87 | $5,011.87 | $5,011.87 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $6,918.31 | Facility | None | $34.67 | $34.67 | $6,918.31 |
Cigna Setting Professional Modifier None Typical Low $4,073.80 Median $6,606.93 Typical High $33,113.11 | Professional | None | $4,073.80 | $6,606.93 | $33,113.11 |
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 $3,019.95 Median $3,801.89 Typical High $6,456.54 | Professional | None | $3,019.95 | $3,801.89 | $6,456.54 |
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 $2,089.30 Median $2,187.76 Typical High $2,187.76 | Professional | 52 · Reduced service | $2,089.30 | $2,187.76 | $2,187.76 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $831.76 Median $870.96 Typical High $870.96 | Professional | 53 · Discontinued | $831.76 | $870.96 | $870.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3,162.28 Median $3,235.94 Typical High $3,235.94 | Professional | 54 · Surgery only | $3,162.28 | $3,235.94 | $3,235.94 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $630.96 Median $645.65 Typical High $645.65 | Professional | 55 · Aftercare only | $630.96 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $416.87 Median $436.52 Typical High $436.52 | Professional | 56 · Pre-op care only | $416.87 | $436.52 | $436.52 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,951.21 Median $3,019.95 Typical High $3,019.95 | Professional | 78 · Unplanned return to OR | $2,951.21 | $3,019.95 | $3,019.95 |
Where West Virginia sits
The same service costs 21.9 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· 34th of 51
$4,365
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.