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 $151.36 Median $229.09 Typical High $229.09 | Facility | None | $151.36 | $229.09 | $229.09 |
Aetna Setting Professional Modifier None Typical Low $138.04 Median $169.82 Typical High $229.09 | Professional | None | $138.04 | $169.82 | $229.09 |
CareSource Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $165.96 | Professional | None | $165.96 | $165.96 | $165.96 |
Cigna Setting Facility Modifier None Typical Low $223.87 Median $416.87 Typical High $1,318.26 | Facility | None | $223.87 | $416.87 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $223.87 Typical High $588.84 | Professional | None | $147.91 | $223.87 | $588.84 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $1,905.46 | Facility | None | $1,905.46 | $1,905.46 | $1,905.46 |
Highmark BCBS Setting Professional Modifier None Typical Low $316.23 Median $316.23 Typical High $316.23 | Professional | None | $316.23 | $316.23 | $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 $125.89 Median $204.17 Typical High $467.74 | Professional | None | $125.89 | $204.17 | $467.74 |
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 $69.18 Median $75.86 Typical High $104.71 | Professional | 52 · Reduced service | $69.18 | $75.86 | $104.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $27.54 Median $30.20 Typical High $41.69 | Professional | 53 · Discontinued | $27.54 | $30.20 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $104.71 Median $112.20 Typical High $158.49 | Professional | 54 · Surgery only | $104.71 | $112.20 | $158.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.89 Median $22.91 Typical High $31.62 | Professional | 55 · Aftercare only | $20.89 | $22.91 | $31.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $15.14 Typical High $20.89 | Professional | 56 · Pre-op care only | $13.80 | $15.14 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $97.72 Median $104.71 Typical High $147.91 | Professional | 78 · Unplanned return to OR | $97.72 | $104.71 | $147.91 |
Where West Virginia sits
The same service costs 3.4 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· 42nd of 51
$209
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.