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 Professional Modifier None Typical Low $28.84 Median $30.20 Typical High $30.20 | Professional | None | $28.84 | $30.20 | $30.20 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $14.45 Median $15.14 Typical High $15.14 | Professional | 52 · Reduced service | $14.45 | $15.14 | $15.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.75 Median $6.03 Typical High $6.03 | Professional | 53 · Discontinued | $5.75 | $6.03 | $6.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.37 Median $4.47 Typical High $4.47 | Professional | 55 · Aftercare only | $4.37 | $4.47 | $4.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.88 Median $3.02 Typical High $3.02 | Professional | 56 · Pre-op care only | $2.88 | $3.02 | $3.02 |
CareSource Setting Facility Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Facility | None | $38.02 | $38.02 | $38.02 |
CareSource Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $69.18 | Professional | None | $40.74 | $40.74 | $69.18 |
Cigna Setting Facility Modifier None Typical Low $38.90 Median $38.90 Typical High $91.20 | Facility | None | $38.90 | $38.90 | $91.20 |
Cigna Setting Professional Modifier None Typical Low $28.18 Median $28.18 Typical High $323.59 | Professional | None | $28.18 | $28.18 | $323.59 |
United Setting Facility Modifier None Typical Low $35.48 Median $38.02 Typical High $67.61 | Facility | None | $35.48 | $38.02 | $67.61 |
United Setting Professional Modifier None Typical Low $27.54 Median $33.11 Typical High $64.57 | Professional | None | $27.54 | $33.11 | $64.57 |
1 more rate 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 |
|---|---|---|---|---|---|
Highmark BCBS Setting Professional Modifier KX · Policy requirements met Typical Low $40.74 Median $40.74 Typical High $40.74 | Professional | KX · Policy requirements met | $40.74 | $40.74 | $40.74 |
Where West Virginia sits
The same service costs 3.0 times more in Hawaii than in Delaware. 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· 47th of 51
$30.20
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.