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 $112.20 Median $147.91 Typical High $162.18 | Facility | None | $112.20 | $147.91 | $162.18 |
Aetna Setting Professional Modifier None Typical Low $100.00 Median $138.04 Typical High $169.82 | Professional | None | $100.00 | $138.04 | $169.82 |
CareSource Setting Professional Modifier None Typical Low $120.23 Median $141.25 Typical High $169.82 | Professional | None | $120.23 | $141.25 | $169.82 |
Cigna Setting Facility Modifier None Typical Low $169.82 Median $288.40 Typical High $1,318.26 | Facility | None | $169.82 | $288.40 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $109.65 Median $154.88 Typical High $398.11 | Professional | None | $109.65 | $154.88 | $398.11 |
Highmark BCBS Setting Facility Modifier None Typical Low $776.25 Median $1,445.44 Typical High $21,877.62 | Facility | None | $776.25 | $1,445.44 | $21,877.62 |
Highmark BCBS Setting Professional Modifier None Typical Low $199.53 Median $234.42 Typical High $239.88 | Professional | None | $199.53 | $234.42 | $239.88 |
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 $95.50 Median $151.36 Typical High $323.59 | Professional | None | $95.50 | $151.36 | $323.59 |
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 $50.12 Median $56.23 Typical High $72.44 | Professional | 52 · Reduced service | $50.12 | $56.23 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $22.39 Typical High $29.51 | Professional | 53 · Discontinued | $20.42 | $22.39 | $29.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $83.18 Typical High $109.65 | Professional | 54 · Surgery only | $75.86 | $83.18 | $109.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $16.60 Typical High $21.88 | Professional | 55 · Aftercare only | $15.14 | $16.60 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $11.22 Typical High $14.79 | Professional | 56 · Pre-op care only | $10.00 | $11.22 | $14.79 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $70.79 Median $77.62 Typical High $102.33 | Professional | 78 · Unplanned return to OR | $70.79 | $77.62 | $102.33 |
Where West Virginia sits
The same service costs 3.5 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· 38th of 51
$151
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.