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 $35.48 Median $100.00 Typical High $100.00 | Facility | None | $35.48 | $100.00 | $100.00 |
Aetna Setting Professional Modifier None Typical Low $32.36 Median $60.26 Typical High $104.71 | Professional | None | $32.36 | $60.26 | $104.71 |
CareSource Setting Professional Modifier None Typical Low $38.02 Median $85.11 Typical High $102.33 | Professional | None | $38.02 | $85.11 | $102.33 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $48.98 | Facility | None | $34.67 | $34.67 | $48.98 |
Cigna Setting Professional Modifier None Typical Low $34.67 Median $95.50 Typical High $239.88 | Professional | None | $34.67 | $95.50 | $239.88 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,023.29 Median $1,288.25 Typical High $1,862.09 | Facility | None | $1,023.29 | $1,288.25 | $1,862.09 |
Highmark BCBS Setting Professional Modifier None Typical Low $70.79 Median $72.44 Typical High $147.91 | Professional | None | $70.79 | $72.44 | $147.91 |
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 $27.54 Median $66.07 Typical High $141.25 | Professional | None | $27.54 | $66.07 | $141.25 |
5 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 $16.22 Median $16.98 Typical High $45.71 | Professional | 52 · Reduced service | $16.22 | $16.98 | $45.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.46 Median $6.76 Typical High $18.20 | Professional | 53 · Discontinued | $6.46 | $6.76 | $18.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $24.55 Median $25.12 Typical High $69.18 | Professional | 54 · Surgery only | $24.55 | $25.12 | $69.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.90 Median $5.13 Typical High $13.80 | Professional | 55 · Aftercare only | $4.90 | $5.13 | $13.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.24 Median $3.39 Typical High $9.12 | Professional | 56 · Pre-op care only | $3.24 | $3.39 | $9.12 |
Where West Virginia sits
The same service costs 3.3 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· 36th of 51
$74.13
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.