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 $181.97 Median $239.88 Typical High $1,621.81 | Facility | None | $181.97 | $239.88 | $1,621.81 |
Aetna Setting Professional Modifier None Typical Low $165.96 Median $194.98 Typical High $239.88 | Professional | None | $165.96 | $194.98 | $239.88 |
CareSource Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | None | $204.17 | $204.17 | $204.17 |
Cigna Setting Facility Modifier None Typical Low $288.40 Median $537.03 Typical High $1,995.26 | Facility | None | $288.40 | $537.03 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $181.97 Median $234.42 Typical High $616.60 | Professional | None | $181.97 | $234.42 | $616.60 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,162.28 Median $3,162.28 Typical High $4,073.80 | Facility | None | $3,162.28 | $3,162.28 | $4,073.80 |
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 $154.88 Median $239.88 Typical High $501.19 | Professional | None | $154.88 | $239.88 | $501.19 |
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 $83.18 Median $91.20 Typical High $109.65 | Professional | 52 · Reduced service | $83.18 | $91.20 | $109.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.11 Median $36.31 Typical High $43.65 | Professional | 53 · Discontinued | $33.11 | $36.31 | $43.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $134.90 Typical High $162.18 | Professional | 54 · Surgery only | $123.03 | $134.90 | $162.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.12 Median $26.92 Typical High $32.36 | Professional | 55 · Aftercare only | $25.12 | $26.92 | $32.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.60 Median $18.20 Typical High $21.88 | Professional | 56 · Pre-op care only | $16.60 | $18.20 | $21.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $125.89 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $114.82 | $125.89 | $151.36 |
Where West Virginia sits
The same service costs 4.7 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· 38th of 51
$234
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.