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 $338.84 Median $338.84 Typical High $338.84 | Professional | None | $338.84 | $338.84 | $338.84 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $169.82 Median $169.82 Typical High $169.82 | Professional | 52 · Reduced service | $169.82 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $67.61 Median $67.61 Typical High $67.61 | Professional | 53 · Discontinued | $67.61 | $67.61 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $50.12 Median $50.12 Typical High $50.12 | Professional | 55 · Aftercare only | $50.12 | $50.12 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $33.88 Median $33.88 Typical High $33.88 | Professional | 56 · Pre-op care only | $33.88 | $33.88 | $33.88 |
CareSource Setting Facility Modifier None Typical Low $446.68 Median $446.68 Typical High $446.68 | Facility | None | $446.68 | $446.68 | $446.68 |
CareSource Setting Professional Modifier None Typical Low $478.63 Median $478.63 Typical High $812.83 | Professional | None | $478.63 | $478.63 | $812.83 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $426.58 Typical High $1,071.52 | Facility | None | $426.58 | $426.58 | $1,071.52 |
Cigna Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $3,801.89 | Professional | None | $309.03 | $309.03 | $3,801.89 |
United Setting Facility Modifier None Typical Low $426.58 Median $457.09 Typical High $794.33 | Facility | None | $426.58 | $457.09 | $794.33 |
United Setting Professional Modifier None Typical Low $338.84 Median $436.52 Typical High $758.58 | Professional | None | $338.84 | $436.52 | $758.58 |
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 + KX · Policy requirements met Typical Low $478.63 Median $478.63 Typical High $478.63 | Professional | K3 · Prosthesis level 3 + KX · Policy requirements met | $478.63 | $478.63 | $478.63 |
Where West Virginia sits
The same service costs 3.8 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
$347
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.