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 $199.53 Median $281.84 Typical High $338.84 | Facility | None | $199.53 | $281.84 | $338.84 |
Aetna Setting Professional Modifier None Typical Low $177.83 Median $239.88 Typical High $295.12 | Professional | None | $177.83 | $239.88 | $295.12 |
CareSource Setting Professional Modifier None Typical Low $213.80 Median $251.19 Typical High $302.00 | Professional | None | $213.80 | $251.19 | $302.00 |
Cigna Setting Facility Modifier None Typical Low $288.40 Median $467.74 Typical High $1,318.26 | Facility | None | $288.40 | $467.74 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $190.55 Median $269.15 Typical High $741.31 | Professional | None | $190.55 | $269.15 | $741.31 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,047.13 Median $2,951.21 Typical High $4,265.80 | Facility | None | $1,047.13 | $2,951.21 | $4,265.80 |
Highmark BCBS Setting Professional Modifier None Typical Low $199.53 Median $363.08 Typical High $407.38 | Professional | None | $199.53 | $363.08 | $407.38 |
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 $151.36 Median $251.19 Typical High $588.84 | Professional | None | $151.36 | $251.19 | $588.84 |
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 $89.13 Median $97.72 Typical High $128.82 | Professional | 52 · Reduced service | $89.13 | $97.72 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $38.90 Typical High $51.29 | Professional | 53 · Discontinued | $35.48 | $38.90 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $144.54 Typical High $190.55 | Professional | 54 · Surgery only | $134.90 | $144.54 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $29.51 Typical High $38.02 | Professional | 55 · Aftercare only | $26.92 | $29.51 | $38.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $19.50 Typical High $25.70 | Professional | 56 · Pre-op care only | $17.78 | $19.50 | $25.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $134.90 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $125.89 | $134.90 | $177.83 |
Where West Virginia sits
The same service costs 3.6 times more in Alaska than in Texas. 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· 42nd of 51
$257
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.