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 $194.98 Median $218.78 Typical High $269.15 | Professional | None | $194.98 | $218.78 | $269.15 |
CareSource Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $245.47 | Professional | None | $245.47 | $245.47 | $245.47 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $331.13 Typical High $371.54 | Facility | None | $34.67 | $331.13 | $371.54 |
Cigna Setting Professional Modifier None Typical Low $223.87 Median $363.08 Typical High $645.65 | Professional | None | $223.87 | $363.08 | $645.65 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $891.25 | Facility | None | $100.00 | $131.83 | $891.25 |
United Setting Professional Modifier None Typical Low $165.96 Median $234.42 Typical High $446.68 | Professional | None | $165.96 | $234.42 | $446.68 |
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 $104.71 Median $117.49 Typical High $134.90 | Professional | 52 · Reduced service | $104.71 | $117.49 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $46.77 Typical High $53.70 | Professional | 53 · Discontinued | $41.69 | $46.77 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $173.78 Typical High $199.53 | Professional | 54 · Surgery only | $158.49 | $173.78 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $34.67 Typical High $39.81 | Professional | 55 · Aftercare only | $31.62 | $34.67 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.89 Median $23.44 Typical High $26.92 | Professional | 56 · Pre-op care only | $20.89 | $23.44 | $26.92 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $147.91 Median $162.18 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $147.91 | $162.18 | $186.21 |
Where West Virginia sits
The same service costs 4.3 times more in Alaska than in Florida. 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· 35th of 51
$263
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.