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 $12.02 Median $12.02 Typical High $12.02 | Professional | None | $12.02 | $12.02 | $12.02 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $6.03 Median $6.03 Typical High $6.03 | Professional | 52 · Reduced service | $6.03 | $6.03 | $6.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.40 Median $2.40 Typical High $2.40 | Professional | 53 · Discontinued | $2.40 | $2.40 | $2.40 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.82 Median $1.82 Typical High $1.82 | Professional | 55 · Aftercare only | $1.82 | $1.82 | $1.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.20 Median $1.20 Typical High $1.20 | Professional | 56 · Pre-op care only | $1.20 | $1.20 | $1.20 |
CareSource Setting Facility Modifier None Typical Low $19.50 Median $19.50 Typical High $19.50 | Facility | None | $19.50 | $19.50 | $19.50 |
CareSource Setting Professional Modifier None Typical Low $20.89 Median $20.89 Typical High $36.31 | Professional | None | $20.89 | $20.89 | $36.31 |
Cigna Setting Facility Modifier None Typical Low $16.22 Median $16.22 Typical High $41.69 | Facility | None | $16.22 | $16.22 | $41.69 |
Cigna Setting Professional Modifier None Typical Low $12.02 Median $12.02 Typical High $131.83 | Professional | None | $12.02 | $12.02 | $131.83 |
United Setting Facility Modifier None Typical Low $12.88 Median $15.49 Typical High $26.92 | Facility | None | $12.88 | $15.49 | $26.92 |
United Setting Professional Modifier None Typical Low $12.02 Median $15.49 Typical High $27.54 | Professional | None | $12.02 | $15.49 | $27.54 |
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 K2 · Prosthesis level 2 + K3 · Prosthesis level 3 + KX · Policy requirements met Typical Low $17.38 Median $17.38 Typical High $17.38 | Professional | K2 · Prosthesis level 2 + K3 · Prosthesis level 3 + KX · Policy requirements met | $17.38 | $17.38 | $17.38 |
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· 50th of 51
$12.30
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.