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 $2,344.23 | Facility | None | $1,412.54 | $1,412.54 | $2,344.23 |
Aetna Setting Professional Modifier None Typical Low $1,258.93 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,258.93 | $1,288.25 | $1,288.25 |
CareSource Setting Professional Modifier None Typical Low $1,479.11 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,479.11 | $1,479.11 | $1,479.11 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $2,089.30 Typical High $13,803.84 | Facility | None | $34.67 | $2,089.30 | $13,803.84 |
Cigna Setting Professional Modifier None Typical Low $1,202.26 Median $1,949.84 Typical High $5,754.40 | Professional | None | $1,202.26 | $1,949.84 | $5,754.40 |
United Setting Facility Modifier None Typical Low $3,981.07 Median $8,511.38 Typical High $29,512.09 | Facility | None | $3,981.07 | $8,511.38 | $29,512.09 |
United Setting Professional Modifier None Typical Low $933.25 Median $1,202.26 Typical High $1,995.26 | Professional | None | $933.25 | $1,202.26 | $1,995.26 |
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 $630.96 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $630.96 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $251.19 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $977.24 Typical High $977.24 | Professional | 54 · Surgery only | $933.25 | $977.24 | $977.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $194.98 Typical High $194.98 | Professional | 55 · Aftercare only | $186.21 | $194.98 | $194.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $128.82 Typical High $128.82 | Professional | 56 · Pre-op care only | $125.89 | $128.82 | $128.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $912.01 Typical High $912.01 | Professional | 78 · Unplanned return to OR | $870.96 | $912.01 | $912.01 |
Where West Virginia sits
The same service costs 25.7 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· 33rd of 51
$1,380
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.