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 $10.23 Median $10.23 Typical High $10.23 | Professional | None | $10.23 | $10.23 | $10.23 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $5.13 Median $5.13 Typical High $5.13 | Professional | 52 · Reduced service | $5.13 | $5.13 | $5.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.04 Median $2.04 Typical High $2.04 | Professional | 53 · Discontinued | $2.04 | $2.04 | $2.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.51 Median $1.51 Typical High $1.51 | Professional | 55 · Aftercare only | $1.51 | $1.51 | $1.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.02 Median $1.02 Typical High $1.02 | Professional | 56 · Pre-op care only | $1.02 | $1.02 | $1.02 |
CareSource Setting Facility Modifier None Typical Low $14.79 Median $14.79 Typical High $14.79 | Facility | None | $14.79 | $14.79 | $14.79 |
CareSource Setting Professional Modifier None Typical Low $15.85 Median $15.85 Typical High $27.54 | Professional | None | $15.85 | $15.85 | $27.54 |
Cigna Setting Facility Modifier None Typical Low $14.45 Median $14.45 Typical High $31.62 | Facility | None | $14.45 | $14.45 | $31.62 |
Cigna Setting Professional Modifier None Typical Low $10.47 Median $10.47 Typical High $107.15 | Professional | None | $10.47 | $10.47 | $107.15 |
United Setting Facility Modifier None Typical Low $12.59 Median $12.88 Typical High $21.88 | Facility | None | $12.59 | $12.88 | $21.88 |
United Setting Professional Modifier None Typical Low $10.23 Median $13.18 Typical High $23.44 | Professional | None | $10.23 | $13.18 | $23.44 |
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 $14.45 Median $14.45 Typical High $14.45 | Professional | K3 · Prosthesis level 3 + KX · Policy requirements met | $14.45 | $14.45 | $14.45 |
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· 49th of 51
$10.47
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.