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 Facility Modifier None Typical Low $97.72 Median $97.72 Typical High $128.82 | Facility | None | $97.72 | $97.72 | $128.82 |
Aetna Setting Professional Modifier None Typical Low $87.10 Median $112.20 Typical High $144.54 | Professional | None | $87.10 | $112.20 | $144.54 |
CareSource Setting Professional Modifier None Typical Low $107.15 Median $117.49 Typical High $141.25 | Professional | None | $107.15 | $117.49 | $141.25 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $158.49 Typical High $234.42 | Facility | None | $34.67 | $158.49 | $234.42 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $181.97 Typical High $338.84 | Professional | None | $104.71 | $181.97 | $338.84 |
Highmark BCBS Setting Facility Modifier None Typical Low $295.12 Median $831.76 Typical High $1,621.81 | Facility | None | $295.12 | $831.76 | $1,621.81 |
Highmark BCBS Setting Professional Modifier None Typical Low $125.89 Median $125.89 Typical High $208.93 | Professional | None | $125.89 | $125.89 | $208.93 |
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 $83.18 Median $123.03 Typical High $275.42 | Professional | None | $83.18 | $123.03 | $275.42 |
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 $43.65 Median $48.98 Typical High $58.88 | Professional | 52 · Reduced service | $43.65 | $48.98 | $58.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $19.50 Typical High $23.44 | Professional | 53 · Discontinued | $17.38 | $19.50 | $23.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $66.07 Median $74.13 Typical High $89.13 | Professional | 54 · Surgery only | $66.07 | $74.13 | $89.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.18 Median $14.79 Typical High $17.78 | Professional | 55 · Aftercare only | $13.18 | $14.79 | $17.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $9.77 Typical High $11.75 | Professional | 56 · Pre-op care only | $8.71 | $9.77 | $11.75 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $61.66 Median $69.18 Typical High $83.18 | Professional | 78 · Unplanned return to OR | $61.66 | $69.18 | $83.18 |
Where West Virginia sits
The same service costs 3.8 times more in Alaska than in Kentucky. 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· 32nd of 51
$129
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.