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 $134.90 Median $169.82 Typical High $263.03 | Professional | None | $134.90 | $169.82 | $263.03 |
CareSource Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | None | $151.36 | $151.36 | $151.36 |
Cigna Setting Facility Modifier None Typical Low $208.93 Median $537.03 Typical High $1,862.09 | Facility | None | $208.93 | $537.03 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $169.82 Median $363.08 Typical High $660.69 | Professional | None | $169.82 | $363.08 | $660.69 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $2,754.23 | Facility | None | $426.58 | $660.69 | $2,754.23 |
United Setting Professional Modifier None Typical Low $104.71 Median $208.93 Typical High $467.74 | Professional | None | $104.71 | $208.93 | $467.74 |
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 $67.61 Median $85.11 Typical High $131.83 | Professional | 52 · Reduced service | $67.61 | $85.11 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $34.67 Typical High $52.48 | Professional | 53 · Discontinued | $26.92 | $34.67 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $128.82 Typical High $199.53 | Professional | 54 · Surgery only | $102.33 | $128.82 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $25.70 Typical High $39.81 | Professional | 55 · Aftercare only | $20.42 | $25.70 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.49 Median $16.98 Typical High $26.30 | Professional | 56 · Pre-op care only | $13.49 | $16.98 | $26.30 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $95.50 Median $120.23 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $95.50 | $120.23 | $186.21 |
Where West Virginia sits
The same service costs 4.7 times more in Alaska than in Virginia. 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· 41st of 51
$234
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.