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 $234.42 Median $288.40 Typical High $288.40 | Facility | None | $234.42 | $288.40 | $288.40 |
Aetna Setting Professional Modifier None Typical Low $208.93 Median $239.88 Typical High $281.84 | Professional | None | $208.93 | $239.88 | $281.84 |
CareSource Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $257.04 | Professional | None | $257.04 | $257.04 | $257.04 |
Cigna Setting Facility Modifier None Typical Low $346.74 Median $398.11 Typical High $1,995.26 | Facility | None | $346.74 | $398.11 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $229.09 Median $281.84 Typical High $741.31 | Professional | None | $229.09 | $281.84 | $741.31 |
Highmark BCBS Setting Facility Modifier None Typical Low $5,754.40 Median $5,754.40 Typical High $5,754.40 | Facility | None | $5,754.40 | $5,754.40 | $5,754.40 |
United Setting Facility Modifier None Typical Low $151.36 Median $436.52 Typical High $4,570.88 | Facility | None | $151.36 | $436.52 | $4,570.88 |
United Setting Professional Modifier None Typical Low $199.53 Median $295.12 Typical High $602.56 | Professional | None | $199.53 | $295.12 | $602.56 |
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 $104.71 Median $114.82 Typical High $131.83 | Professional | 52 · Reduced service | $104.71 | $114.82 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $42.66 Median $45.71 Typical High $52.48 | Professional | 53 · Discontinued | $42.66 | $45.71 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $169.82 Typical High $199.53 | Professional | 54 · Surgery only | $158.49 | $169.82 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $33.88 Typical High $39.81 | Professional | 55 · Aftercare only | $31.62 | $33.88 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.89 Median $22.91 Typical High $26.30 | Professional | 56 · Pre-op care only | $20.89 | $22.91 | $26.30 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $147.91 Median $158.49 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $147.91 | $158.49 | $186.21 |
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· 38th of 51
$282
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.