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 $104.71 Median $125.89 Typical High $154.88 | Professional | None | $104.71 | $125.89 | $154.88 |
CareSource Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $128.82 | Professional | None | $128.82 | $128.82 | $128.82 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $181.97 Typical High $245.47 | Facility | None | $34.67 | $181.97 | $245.47 |
Cigna Setting Professional Modifier None Typical Low $131.83 Median $199.53 Typical High $1,230.27 | Professional | None | $131.83 | $199.53 | $1,230.27 |
United Setting Facility Modifier None Typical Low $1,202.26 Median $1,479.11 Typical High $9,120.11 | Facility | None | $1,202.26 | $1,479.11 | $9,120.11 |
United Setting Professional Modifier None Typical Low $95.50 Median $151.36 Typical High $316.23 | Professional | None | $95.50 | $151.36 | $316.23 |
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 $52.48 Median $63.10 Typical High $77.62 | Professional | 52 · Reduced service | $52.48 | $63.10 | $77.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $25.12 Typical High $30.90 | Professional | 53 · Discontinued | $20.89 | $25.12 | $30.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $95.50 Typical High $114.82 | Professional | 54 · Surgery only | $79.43 | $95.50 | $114.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $19.05 Typical High $22.91 | Professional | 55 · Aftercare only | $15.85 | $19.05 | $22.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $12.59 Typical High $15.49 | Professional | 56 · Pre-op care only | $10.47 | $12.59 | $15.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $89.13 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $74.13 | $89.13 | $107.15 |
Where West Virginia sits
The same service costs 3.6 times more in Wisconsin 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· 36th of 51
$162
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.