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 $5.37 Median $5.37 Typical High $5.37 | Professional | None | $5.37 | $5.37 | $5.37 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $2.69 Median $2.69 Typical High $2.69 | Professional | 52 · Reduced service | $2.69 | $2.69 | $2.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.07 Median $1.07 Typical High $1.07 | Professional | 53 · Discontinued | $1.07 | $1.07 | $1.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.81 Median $0.81 Typical High $0.81 | Professional | 55 · Aftercare only | $0.81 | $0.81 | $0.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.54 Median $0.54 Typical High $0.54 | Professional | 56 · Pre-op care only | $0.54 | $0.54 | $0.54 |
CareSource Setting Facility Modifier None Typical Low $7.24 Median $7.24 Typical High $7.24 | Facility | None | $7.24 | $7.24 | $7.24 |
CareSource Setting Professional Modifier None Typical Low $7.76 Median $7.76 Typical High $13.18 | Professional | None | $7.76 | $7.76 | $13.18 |
Cigna Setting Facility Modifier None Typical Low $7.08 Median $7.08 Typical High $16.98 | Facility | None | $7.08 | $7.08 | $16.98 |
Cigna Setting Professional Modifier None Typical Low $5.25 Median $5.25 Typical High $60.26 | Professional | None | $5.25 | $5.25 | $60.26 |
United Setting Facility Modifier None Typical Low $6.31 Median $7.94 Typical High $12.88 | Facility | None | $6.31 | $7.94 | $12.88 |
United Setting Professional Modifier None Typical Low $5.37 Median $7.08 Typical High $12.30 | Professional | None | $5.37 | $7.08 | $12.30 |
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 Typical Low $9.12 Median $9.12 Typical High $9.12 | Professional | K2 · Prosthesis level 2 | $9.12 | $9.12 | $9.12 |
Where West Virginia sits
The same service costs 3.5 times more in Montana than in Kansas. 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· 47th of 51
$5.50
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.