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 $1,412.54 Median $1,412.54 Typical High $1,621.81 | Facility | None | $1,412.54 | $1,412.54 | $1,621.81 |
Aetna Setting Professional Modifier None Typical Low $199.53 Median $263.03 Typical High $323.59 | Professional | None | $199.53 | $263.03 | $323.59 |
CareSource Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | None | $239.88 | $239.88 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $316.23 Median $537.03 Typical High $1,659.59 | Facility | None | $316.23 | $537.03 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $213.80 Median $302.00 Typical High $812.83 | Professional | None | $213.80 | $302.00 | $812.83 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,290.87 Median $2,691.53 Typical High $5,623.41 | Facility | None | $2,290.87 | $2,691.53 | $5,623.41 |
Highmark BCBS Setting Professional Modifier None Typical Low $263.03 Median $426.58 Typical High $467.74 | Professional | None | $263.03 | $426.58 | $467.74 |
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 $169.82 Median $281.84 Typical High $645.65 | Professional | None | $169.82 | $281.84 | $645.65 |
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 $100.00 Median $107.15 Typical High $141.25 | Professional | 52 · Reduced service | $100.00 | $107.15 | $141.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $42.66 Typical High $57.54 | Professional | 53 · Discontinued | $39.81 | $42.66 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $162.18 Typical High $213.80 | Professional | 54 · Surgery only | $147.91 | $162.18 | $213.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $32.36 Typical High $42.66 | Professional | 55 · Aftercare only | $29.51 | $32.36 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $21.38 Typical High $28.18 | Professional | 56 · Pre-op care only | $19.95 | $21.38 | $28.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $151.36 Typical High $199.53 | Professional | 78 · Unplanned return to OR | $138.04 | $151.36 | $199.53 |
Where West Virginia sits
The same service costs 3.6 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· 45th 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.