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 $38.02 Median $74.13 Typical High $194.98 | Professional | None | $38.02 | $74.13 | $194.98 |
CareSource Setting Professional Modifier None Typical Low $41.69 Median $41.69 Typical High $41.69 | Professional | None | $41.69 | $41.69 | $41.69 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $57.54 | Facility | None | $34.67 | $34.67 | $57.54 |
Cigna Setting Professional Modifier None Typical Low $52.48 Median $181.97 Typical High $831.76 | Professional | None | $52.48 | $181.97 | $831.76 |
United Setting Facility Modifier None Typical Low $457.09 Median $457.09 Typical High $457.09 | Facility | None | $457.09 | $457.09 | $457.09 |
United Setting Professional Modifier None Typical Low $36.31 Median $102.33 Typical High $331.13 | Professional | None | $36.31 | $102.33 | $331.13 |
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 $19.05 Median $20.42 Typical High $87.10 | Professional | 52 · Reduced service | $19.05 | $20.42 | $87.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.59 Median $8.13 Typical High $34.67 | Professional | 53 · Discontinued | $7.59 | $8.13 | $34.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $28.18 Median $30.90 Typical High $131.83 | Professional | 54 · Surgery only | $28.18 | $30.90 | $131.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $6.17 Typical High $26.30 | Professional | 55 · Aftercare only | $5.62 | $6.17 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.80 Median $4.07 Typical High $17.38 | Professional | 56 · Pre-op care only | $3.80 | $4.07 | $17.38 |
Where West Virginia sits
The same service costs 4.5 times more in Wisconsin than in Michigan. 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· 40th of 51
$123
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.