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 $38.90 Median $46.77 Typical High $74.13 | Professional | None | $38.90 | $46.77 | $74.13 |
CareSource Setting Professional Modifier None Typical Low $46.77 Median $46.77 Typical High $46.77 | Professional | None | $46.77 | $46.77 | $46.77 |
Cigna Setting Facility Modifier None Typical Low $66.07 Median $144.54 Typical High $1,318.26 | Facility | None | $66.07 | $144.54 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $51.29 Median $112.20 Typical High $446.68 | Professional | None | $51.29 | $112.20 | $446.68 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $457.09 | Facility | None | $100.00 | $131.83 | $457.09 |
United Setting Professional Modifier None Typical Low $35.48 Median $69.18 Typical High $177.83 | Professional | None | $35.48 | $69.18 | $177.83 |
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 $19.50 Median $23.44 Typical High $37.15 | Professional | 52 · Reduced service | $19.50 | $23.44 | $37.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.76 Median $9.33 Typical High $14.79 | Professional | 53 · Discontinued | $7.76 | $9.33 | $14.79 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $28.84 Median $35.48 Typical High $54.95 | Professional | 54 · Surgery only | $28.84 | $35.48 | $54.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.89 Median $7.08 Typical High $11.22 | Professional | 55 · Aftercare only | $5.89 | $7.08 | $11.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.89 Median $4.68 Typical High $7.41 | Professional | 56 · Pre-op care only | $3.89 | $4.68 | $7.41 |
Where West Virginia sits
The same service costs 3.2 times more in Wisconsin than in Kentucky. 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· 44th of 51
$74.13
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.