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 $169.82 Median $229.09 Typical High $1,412.54 | Facility | None | $169.82 | $229.09 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $151.36 Median $190.55 Typical High $234.42 | Professional | None | $151.36 | $190.55 | $234.42 |
CareSource Setting Professional Modifier None Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | None | $186.21 | $186.21 | $186.21 |
Cigna Setting Facility Modifier None Typical Low $263.03 Median $398.11 Typical High $1,995.26 | Facility | None | $263.03 | $398.11 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $165.96 Median $218.78 Typical High $562.34 | Professional | None | $165.96 | $218.78 | $562.34 |
Highmark BCBS Setting Facility Modifier None Typical Low $691.83 Median $4,677.35 Typical High $10,964.78 | Facility | None | $691.83 | $4,677.35 | $10,964.78 |
Highmark BCBS Setting Professional Modifier None Typical Low $229.09 Median $309.03 Typical High $309.03 | Professional | None | $229.09 | $309.03 | $309.03 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $4,570.88 | Facility | None | $426.58 | $660.69 | $4,570.88 |
United Setting Professional Modifier None Typical Low $134.90 Median $218.78 Typical High $446.68 | Professional | None | $134.90 | $218.78 | $446.68 |
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 $75.86 Median $83.18 Typical High $102.33 | Professional | 52 · Reduced service | $75.86 | $83.18 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.90 Median $33.88 Typical High $41.69 | Professional | 53 · Discontinued | $30.90 | $33.88 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $114.82 Median $125.89 Typical High $154.88 | Professional | 54 · Surgery only | $114.82 | $125.89 | $154.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.91 Median $25.12 Typical High $30.90 | Professional | 55 · Aftercare only | $22.91 | $25.12 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $16.98 Typical High $20.89 | Professional | 56 · Pre-op care only | $15.14 | $16.98 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $107.15 Median $117.49 Typical High $144.54 | Professional | 78 · Unplanned return to OR | $107.15 | $117.49 | $144.54 |
Where West Virginia sits
The same service costs 4.6 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· 35th of 51
$219
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.