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 $43.65 Median $43.65 Typical High $43.65 | Professional | None | $43.65 | $43.65 | $43.65 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $21.88 Median $21.88 Typical High $21.88 | Professional | 52 · Reduced service | $21.88 | $21.88 | $21.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.71 Median $8.71 Typical High $8.71 | Professional | 53 · Discontinued | $8.71 | $8.71 | $8.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.46 Median $6.46 Typical High $6.46 | Professional | 55 · Aftercare only | $6.46 | $6.46 | $6.46 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.37 Median $4.37 Typical High $4.37 | Professional | 56 · Pre-op care only | $4.37 | $4.37 | $4.37 |
CareSource Setting Facility Modifier None Typical Low $58.88 Median $58.88 Typical High $58.88 | Facility | None | $58.88 | $58.88 | $58.88 |
CareSource Setting Professional Modifier None Typical Low $64.57 Median $64.57 Typical High $109.65 | Professional | None | $64.57 | $64.57 | $109.65 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $50.12 Typical High $125.89 | Facility | None | $50.12 | $50.12 | $125.89 |
Cigna Setting Professional Modifier None Typical Low $37.15 Median $37.15 Typical High $446.68 | Professional | None | $37.15 | $37.15 | $446.68 |
United Setting Facility Modifier None Typical Low $44.67 Median $44.67 Typical High $93.33 | Facility | None | $44.67 | $44.67 | $93.33 |
United Setting Professional Modifier None Typical Low $43.65 Median $56.23 Typical High $97.72 | Professional | None | $43.65 | $56.23 | $97.72 |
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 $61.66 Median $61.66 Typical High $61.66 | Professional | K3 · Prosthesis level 3 | $61.66 | $61.66 | $61.66 |
Where West Virginia sits
The same service costs 2.8 times more in Kansas 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· 48th of 51
$44.67
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.