How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 Facility Modifier None Typical Low $186.21 Median $218.78 Typical High $251.19 | Facility | None | $186.21 | $218.78 | $251.19 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $199.53 Typical High $239.88 | Professional | None | $169.82 | $199.53 | $239.88 |
CareSource Setting Professional Modifier None Typical Low $194.98 Median $199.53 Typical High $234.42 | Professional | None | $194.98 | $199.53 | $234.42 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $302.00 Typical High $354.81 | Facility | None | $34.67 | $302.00 | $354.81 |
Cigna Setting Professional Modifier None Typical Low $177.83 Median $309.03 Typical High $549.54 | Professional | None | $177.83 | $309.03 | $549.54 |
Highmark BCBS Setting Facility Modifier None Typical Low $512.86 Median $831.76 Typical High $2,398.83 | Facility | None | $512.86 | $831.76 | $2,398.83 |
Highmark BCBS Setting Professional Modifier None Typical Low $295.12 Median $295.12 Typical High $295.12 | Professional | None | $295.12 | $295.12 | $295.12 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $1,148.15 | Facility | None | $100.00 | $131.83 | $1,148.15 |
United Setting Professional Modifier None Typical Low $141.25 Median $213.80 Typical High $416.87 | Professional | None | $141.25 | $213.80 | $416.87 |
6 more rates 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 |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $85.11 Median $93.33 Typical High $97.72 | Professional | 52 · Reduced service | $85.11 | $93.33 | $97.72 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $37.15 Typical High $39.81 | Professional | 53 · Discontinued | $33.88 | $37.15 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $138.04 Typical High $147.91 | Professional | 54 · Surgery only | $128.82 | $138.04 | $147.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $27.54 Typical High $29.51 | Professional | 55 · Aftercare only | $25.70 | $27.54 | $29.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $18.62 Typical High $19.95 | Professional | 56 · Pre-op care only | $16.98 | $18.62 | $19.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $128.82 Typical High $138.04 | Professional | 78 · Unplanned return to OR | $120.23 | $128.82 | $138.04 |
Where West Virginia sits
The same service costs 4.4 times more in Alaska than in Florida. 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· 31st of 51
$224
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.