How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $104.71 Median $128.82 Typical High $162.18 | Facility | None | $104.71 | $128.82 | $162.18 |
Aetna Setting Professional Modifier None Typical Low $95.50 Median $123.03 Typical High $158.49 | Professional | None | $95.50 | $123.03 | $158.49 |
CareSource Setting Professional Modifier None Typical Low $117.49 Median $117.49 Typical High $117.49 | Professional | None | $117.49 | $117.49 | $117.49 |
Cigna Setting Facility Modifier None Typical Low $165.96 Median $281.84 Typical High $1,318.26 | Facility | None | $165.96 | $281.84 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $138.04 Typical High $338.84 | Professional | None | $104.71 | $138.04 | $338.84 |
Highmark BCBS Setting Facility Modifier None Typical Low $776.25 Median $1,513.56 Typical High $6,760.83 | Facility | None | $776.25 | $1,513.56 | $6,760.83 |
Highmark BCBS Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | None | $177.83 | $177.83 | $177.83 |
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 $87.10 Median $138.04 Typical High $269.15 | Professional | None | $87.10 | $138.04 | $269.15 |
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 $47.86 Median $54.95 Typical High $64.57 | Professional | 52 · Reduced service | $47.86 | $54.95 | $64.57 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $21.88 Typical High $25.70 | Professional | 53 · Discontinued | $19.05 | $21.88 | $25.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $70.79 Median $83.18 Typical High $97.72 | Professional | 54 · Surgery only | $70.79 | $83.18 | $97.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.45 Median $16.60 Typical High $19.50 | Professional | 55 · Aftercare only | $14.45 | $16.60 | $19.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $10.96 Typical High $12.88 | Professional | 56 · Pre-op care only | $9.55 | $10.96 | $12.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $66.07 Median $77.62 Typical High $91.20 | Professional | 78 · Unplanned return to OR | $66.07 | $77.62 | $91.20 |
Where West Virginia sits
The same service costs 4.1 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· 32nd of 51
$138
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.