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 $1,621.81 | Facility | None | $1,412.54 | $1,412.54 | $1,621.81 |
Aetna Setting Professional Modifier None Typical Low $208.93 Median $229.09 Typical High $812.83 | Professional | None | $208.93 | $229.09 | $812.83 |
CareSource Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | None | $239.88 | $239.88 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $331.13 | Facility | None | $34.67 | $34.67 | $331.13 |
Cigna Setting Professional Modifier None Typical Low $295.12 Median $812.83 Typical High $2,089.30 | Professional | None | $295.12 | $812.83 | $2,089.30 |
United Setting Facility Modifier None Typical Low $2,884.03 Median $2,884.03 Typical High $10,000.00 | Facility | None | $2,884.03 | $2,884.03 | $10,000.00 |
United Setting Professional Modifier None Typical Low $208.93 Median $588.84 Typical High $1,862.09 | Professional | None | $208.93 | $588.84 | $1,862.09 |
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 $104.71 Median $114.82 Typical High $398.11 | Professional | 52 · Reduced service | $104.71 | $114.82 | $398.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $45.71 Typical High $162.18 | Professional | 53 · Discontinued | $41.69 | $45.71 | $162.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $162.18 Typical High $602.56 | Professional | 54 · Surgery only | $158.49 | $162.18 | $602.56 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $34.67 Typical High $120.23 | Professional | 55 · Aftercare only | $31.62 | $34.67 | $120.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.89 Median $22.91 Typical High $81.28 | Professional | 56 · Pre-op care only | $20.89 | $22.91 | $81.28 |
Where West Virginia sits
The same service costs 5.4 times more in Wisconsin than in Maryland. 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· 42nd of 51
$631
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.