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 $1,230.27 Median $1,230.27 Typical High $1,412.54 | Facility | None | $1,230.27 | $1,230.27 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $114.82 Median $125.89 Typical High $181.97 | Professional | None | $114.82 | $125.89 | $181.97 |
CareSource Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $138.04 | Professional | None | $138.04 | $138.04 | $138.04 |
Cigna Setting Facility Modifier None Typical Low $190.55 Median $380.19 Typical High $1,318.26 | Facility | None | $190.55 | $380.19 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $123.03 Median $190.55 Typical High $489.78 | Professional | None | $123.03 | $190.55 | $489.78 |
Highmark BCBS Setting Facility Modifier None Typical Low $30,199.52 Median $30,199.52 Typical High $30,199.52 | Facility | None | $30,199.52 | $30,199.52 | $30,199.52 |
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 $95.50 Median $165.96 Typical High $380.19 | Professional | None | $95.50 | $165.96 | $380.19 |
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 $57.54 Median $63.10 Typical High $91.20 | Professional | 52 · Reduced service | $57.54 | $63.10 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $25.12 Typical High $36.31 | Professional | 53 · Discontinued | $22.91 | $25.12 | $36.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $93.33 Typical High $134.90 | Professional | 54 · Surgery only | $85.11 | $93.33 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $18.62 Typical High $26.92 | Professional | 55 · Aftercare only | $16.98 | $18.62 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $12.59 Typical High $18.20 | Professional | 56 · Pre-op care only | $11.48 | $12.59 | $18.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $87.10 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $79.43 | $87.10 | $125.89 |
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· 37th of 51
$182
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.