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 $158.49 Median $208.93 Typical High $208.93 | Facility | None | $158.49 | $208.93 | $208.93 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $177.83 Typical High $218.78 | Professional | None | $144.54 | $177.83 | $218.78 |
CareSource Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | None | $177.83 | $177.83 | $177.83 |
Cigna Setting Facility Modifier None Typical Low $251.19 Median $363.08 Typical High $1,318.26 | Facility | None | $251.19 | $363.08 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $199.53 Typical High $524.81 | Professional | None | $158.49 | $199.53 | $524.81 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,778.28 Median $3,715.35 Typical High $8,128.31 | Facility | None | $1,778.28 | $3,715.35 | $8,128.31 |
Highmark BCBS Setting Professional Modifier None Typical Low $281.84 Median $281.84 Typical High $338.84 | Professional | None | $281.84 | $281.84 | $338.84 |
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 $131.83 Median $208.93 Typical High $426.58 | Professional | None | $131.83 | $208.93 | $426.58 |
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 $72.44 Median $79.43 Typical High $93.33 | Professional | 52 · Reduced service | $72.44 | $79.43 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $31.62 Typical High $38.02 | Professional | 53 · Discontinued | $28.84 | $31.62 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $120.23 Typical High $141.25 | Professional | 54 · Surgery only | $107.15 | $120.23 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $23.99 Typical High $28.18 | Professional | 55 · Aftercare only | $21.88 | $23.99 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $15.85 Typical High $19.05 | Professional | 56 · Pre-op care only | $14.45 | $15.85 | $19.05 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $112.20 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $100.00 | $112.20 | $131.83 |
Where West Virginia sits
The same service costs 4.0 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
$200
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.