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 $177.83 Median $208.93 Typical High $229.09 | Professional | None | $177.83 | $208.93 | $229.09 |
CareSource Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $218.78 | Professional | None | $218.78 | $218.78 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $302.00 Median $537.03 Typical High $2,691.53 | Facility | None | $302.00 | $537.03 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $354.81 Typical High $2,238.72 | Professional | None | $204.17 | $354.81 | $2,238.72 |
United Setting Facility Modifier None Typical Low $1,202.26 Median $1,479.11 Typical High $5,888.44 | Facility | None | $1,202.26 | $1,479.11 | $5,888.44 |
United Setting Professional Modifier None Typical Low $158.49 Median $239.88 Typical High $562.34 | Professional | None | $158.49 | $239.88 | $562.34 |
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 $89.13 Median $104.71 Typical High $114.82 | Professional | 52 · Reduced service | $89.13 | $104.71 | $114.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $42.66 Typical High $45.71 | Professional | 53 · Discontinued | $35.48 | $42.66 | $45.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $158.49 Typical High $169.82 | Professional | 54 · Surgery only | $131.83 | $158.49 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $31.62 Typical High $33.88 | Professional | 55 · Aftercare only | $26.30 | $31.62 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $20.89 Typical High $22.91 | Professional | 56 · Pre-op care only | $17.78 | $20.89 | $22.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $123.03 Median $147.91 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $123.03 | $147.91 | $158.49 |
Where West Virginia sits
The same service costs 5.6 times more in Oklahoma than in Utah. 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
$288
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.