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 $117.49 Median $158.49 Typical High $173.78 | Facility | None | $117.49 | $158.49 | $173.78 |
Aetna Setting Professional Modifier None Typical Low $107.15 Median $141.25 Typical High $181.97 | Professional | None | $107.15 | $141.25 | $181.97 |
CareSource Setting Professional Modifier None Typical Low $128.82 Median $151.36 Typical High $181.97 | Professional | None | $128.82 | $151.36 | $181.97 |
Cigna Setting Facility Modifier None Typical Low $177.83 Median $323.59 Typical High $1,318.26 | Facility | None | $177.83 | $323.59 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $165.96 Typical High $426.58 | Professional | None | $114.82 | $165.96 | $426.58 |
Highmark BCBS Setting Facility Modifier None Typical Low $660.69 Median $2,290.87 Typical High $3,715.35 | Facility | None | $660.69 | $2,290.87 | $3,715.35 |
Highmark BCBS Setting Professional Modifier None Typical Low $218.78 Median $229.09 Typical High $245.47 | Professional | None | $218.78 | $229.09 | $245.47 |
United Setting Facility Modifier None Typical Low $151.36 Median $436.52 Typical High $1,995.26 | Facility | None | $151.36 | $436.52 | $1,995.26 |
United Setting Professional Modifier None Typical Low $97.72 Median $158.49 Typical High $338.84 | Professional | None | $97.72 | $158.49 | $338.84 |
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 $53.70 Median $58.88 Typical High $79.43 | Professional | 52 · Reduced service | $53.70 | $58.88 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $23.44 Typical High $31.62 | Professional | 53 · Discontinued | $21.38 | $23.44 | $31.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $89.13 Typical High $117.49 | Professional | 54 · Surgery only | $79.43 | $89.13 | $117.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $17.78 Typical High $23.44 | Professional | 55 · Aftercare only | $16.22 | $17.78 | $23.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.72 Median $11.75 Typical High $15.85 | Professional | 56 · Pre-op care only | $10.72 | $11.75 | $15.85 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $83.18 Typical High $109.65 | Professional | 78 · Unplanned return to OR | $74.13 | $83.18 | $109.65 |
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· 36th of 51
$162
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.