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 $251.19 Median $316.23 Typical High $426.58 | Professional | None | $251.19 | $316.23 | $426.58 |
CareSource Setting Professional Modifier None Typical Low $275.42 Median $275.42 Typical High $275.42 | Professional | None | $275.42 | $275.42 | $275.42 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $371.54 Typical High $467.74 | Facility | None | $34.67 | $371.54 | $467.74 |
Cigna Setting Professional Modifier None Typical Low $309.03 Median $630.96 Typical High $1,096.48 | Professional | None | $309.03 | $630.96 | $1,096.48 |
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 $199.53 Median $354.81 Typical High $741.31 | Professional | None | $199.53 | $354.81 | $741.31 |
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 $125.89 Median $158.49 Typical High $213.80 | Professional | 52 · Reduced service | $125.89 | $158.49 | $213.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $50.12 Median $63.10 Typical High $85.11 | Professional | 53 · Discontinued | $50.12 | $63.10 | $85.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $239.88 Typical High $323.59 | Professional | 54 · Surgery only | $190.55 | $239.88 | $323.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $47.86 Typical High $64.57 | Professional | 55 · Aftercare only | $38.02 | $47.86 | $64.57 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.12 Median $31.62 Typical High $42.66 | Professional | 56 · Pre-op care only | $25.12 | $31.62 | $42.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $223.87 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $177.83 | $223.87 | $302.00 |
Where West Virginia sits
The same service costs 3.4 times more in Alaska than in Maryland. 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· 39th of 51
$380
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.