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 $131.83 Median $131.83 Typical High $131.83 | Professional | None | $131.83 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $66.07 Median $66.07 Typical High $66.07 | Professional | 52 · Reduced service | $66.07 | $66.07 | $66.07 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $26.30 Typical High $26.30 | Professional | 53 · Discontinued | $26.30 | $26.30 | $26.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $19.50 Typical High $19.50 | Professional | 55 · Aftercare only | $19.50 | $19.50 | $19.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $13.18 Typical High $13.18 | Professional | 56 · Pre-op care only | $13.18 | $13.18 | $13.18 |
CareSource Setting Facility Modifier None Typical Low $190.55 Median $190.55 Typical High $190.55 | Facility | None | $190.55 | $190.55 | $190.55 |
CareSource Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $354.81 | Professional | None | $204.17 | $204.17 | $354.81 |
Cigna Setting Facility Modifier None Typical Low $165.96 Median $165.96 Typical High $407.38 | Facility | None | $165.96 | $165.96 | $407.38 |
Cigna Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $1,445.44 | Professional | None | $120.23 | $120.23 | $1,445.44 |
United Setting Facility Modifier None Typical Low $134.90 Median $141.25 Typical High $309.03 | Facility | None | $134.90 | $141.25 | $309.03 |
United Setting Professional Modifier None Typical Low $128.82 Median $169.82 Typical High $295.12 | Professional | None | $128.82 | $169.82 | $295.12 |
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 $186.21 Median $186.21 Typical High $186.21 | Professional | K3 · Prosthesis level 3 | $186.21 | $186.21 | $186.21 |
Where West Virginia sits
The same service costs 2.8 times more in Montana 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
$132
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.