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 $186.21 Median $186.21 Typical High $186.21 | Professional | None | $186.21 | $186.21 | $186.21 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $93.33 Median $93.33 Typical High $93.33 | Professional | 52 · Reduced service | $93.33 | $93.33 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $37.15 Typical High $37.15 | Professional | 53 · Discontinued | $37.15 | $37.15 | $37.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | 55 · Aftercare only | $28.18 | $28.18 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $18.62 Typical High $18.62 | Professional | 56 · Pre-op care only | $18.62 | $18.62 | $18.62 |
CareSource Setting Facility Modifier None Typical Low $234.42 Median $234.42 Typical High $234.42 | Facility | None | $234.42 | $234.42 | $234.42 |
CareSource Setting Professional Modifier None Typical Low $251.19 Median $251.19 Typical High $426.58 | Professional | None | $251.19 | $251.19 | $426.58 |
Cigna Setting Facility Modifier None Typical Low $269.15 Median $269.15 Typical High $512.86 | Facility | None | $269.15 | $269.15 | $512.86 |
Cigna Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $1,819.70 | Professional | None | $199.53 | $199.53 | $1,819.70 |
United Setting Facility Modifier None Typical Low $158.49 Median $173.78 Typical High $389.05 | Facility | None | $158.49 | $173.78 | $389.05 |
United Setting Professional Modifier None Typical Low $186.21 Median $234.42 Typical High $426.58 | Professional | None | $186.21 | $234.42 | $426.58 |
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 K3 · Prosthesis level 3 Typical Low $263.03 Median $263.03 Typical High $263.03 | Professional | K3 · Prosthesis level 3 | $263.03 | $263.03 | $263.03 |
Where West Virginia sits
The same service costs 2.0 times more in Wisconsin than in Colorado. 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· 45th of 51
$200
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.