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 $134.90 Median $177.83 Typical High $1,412.54 | Facility | None | $134.90 | $177.83 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $134.90 Median $158.49 Typical High $194.98 | Professional | None | $134.90 | $158.49 | $194.98 |
CareSource Setting Professional Modifier None Typical Low $162.18 Median $173.78 Typical High $208.93 | Professional | None | $162.18 | $173.78 | $208.93 |
Cigna Setting Facility Modifier None Typical Low $229.09 Median $354.81 Typical High $1,318.26 | Facility | None | $229.09 | $354.81 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $190.55 Typical High $478.63 | Professional | None | $147.91 | $190.55 | $478.63 |
Highmark BCBS Setting Facility Modifier None Typical Low $363.08 Median $3,235.94 Typical High $7,762.47 | Facility | None | $363.08 | $3,235.94 | $7,762.47 |
Highmark BCBS Setting Professional Modifier None Typical Low $239.88 Median $269.15 Typical High $316.23 | Professional | None | $239.88 | $269.15 | $316.23 |
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 $123.03 Median $194.98 Typical High $389.05 | Professional | None | $123.03 | $194.98 | $389.05 |
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 $67.61 Median $75.86 Typical High $89.13 | Professional | 52 · Reduced service | $67.61 | $75.86 | $89.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $30.20 Typical High $35.48 | Professional | 53 · Discontinued | $26.92 | $30.20 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $112.20 Typical High $131.83 | Professional | 54 · Surgery only | $100.00 | $112.20 | $131.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $22.39 Typical High $26.30 | Professional | 55 · Aftercare only | $20.42 | $22.39 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.49 Median $15.14 Typical High $17.78 | Professional | 56 · Pre-op care only | $13.49 | $15.14 | $17.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $93.33 Median $104.71 Typical High $123.03 | Professional | 78 · Unplanned return to OR | $93.33 | $104.71 | $123.03 |
Where West Virginia sits
The same service costs 3.9 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
$191
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.