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 $102.33 Median $102.33 Typical High $123.03 | Professional | None | $102.33 | $102.33 | $123.03 |
CareSource Setting Facility Modifier None Typical Low $131.83 Median $131.83 Typical High $131.83 | Facility | None | $131.83 | $131.83 | $131.83 |
CareSource Setting Professional Modifier None Typical Low $141.25 Median $204.17 Typical High $338.84 | Professional | None | $141.25 | $204.17 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $281.84 | Facility | None | $125.89 | $125.89 | $281.84 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $93.33 Typical High $977.24 | Professional | None | $93.33 | $93.33 | $977.24 |
Cigna Setting Professional Modifier RR · Rental Typical Low $10.72 Median $10.72 Typical High $12.59 | Professional | RR · Rental | $10.72 | $10.72 | $12.59 |
United Setting Facility Modifier None Typical Low $208.93 Median $208.93 Typical High $208.93 | Facility | None | $208.93 | $208.93 | $208.93 |
United Setting Professional Modifier None Typical Low $97.72 Median $123.03 Typical High $229.09 | Professional | None | $97.72 | $123.03 | $229.09 |
5 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 $50.12 Median $51.29 Typical High $51.29 | Professional | 52 · Reduced service | $50.12 | $51.29 | $51.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $20.42 Typical High $20.42 | Professional | 53 · Discontinued | $19.95 | $20.42 | $20.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $15.14 Typical High $15.14 | Professional | 55 · Aftercare only | $15.14 | $15.14 | $15.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $10.23 Typical High $10.23 | Professional | 56 · Pre-op care only | $10.00 | $10.23 | $10.23 |
Highmark BCBS Setting Professional Modifier KX · Policy requirements met Typical Low $138.04 Median $138.04 Typical High $138.04 | Professional | KX · Policy requirements met | $138.04 | $138.04 | $138.04 |
Where West Virginia sits
The same service costs 2.1 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· 49th of 51
$102
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.