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 $223.87 Median $257.04 Typical High $309.03 | Professional | None | $223.87 | $257.04 | $309.03 |
CareSource Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $269.15 | Professional | None | $269.15 | $269.15 | $269.15 |
Cigna Setting Facility Modifier None Typical Low $354.81 Median $537.03 Typical High $1,995.26 | Facility | None | $354.81 | $537.03 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $239.88 Median $331.13 Typical High $891.25 | Professional | None | $239.88 | $331.13 | $891.25 |
Highmark BCBS Setting Facility Modifier None Typical Low $6,309.57 Median $6,309.57 Typical High $6,309.57 | Facility | None | $6,309.57 | $6,309.57 | $6,309.57 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $4,570.88 | Facility | None | $426.58 | $660.69 | $4,570.88 |
United Setting Professional Modifier None Typical Low $199.53 Median $316.23 Typical High $707.95 | Professional | None | $199.53 | $316.23 | $707.95 |
7 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 $112.20 Median $120.23 Typical High $154.88 | Professional | 52 · Reduced service | $112.20 | $120.23 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $44.67 Median $47.86 Typical High $61.66 | Professional | 53 · Discontinued | $44.67 | $47.86 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $165.96 Median $177.83 Typical High $234.42 | Professional | 54 · Surgery only | $165.96 | $177.83 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $35.48 Typical High $46.77 | Professional | 55 · Aftercare only | $33.88 | $35.48 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.39 Median $23.99 Typical High $30.90 | Professional | 56 · Pre-op care only | $22.39 | $23.99 | $30.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $154.88 Median $165.96 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $154.88 | $165.96 | $218.78 |
Highmark BCBS Setting Professional Modifier 59 · Distinct service Typical Low $436.52 Median $436.52 Typical High $436.52 | Professional | 59 · Distinct service | $436.52 | $436.52 | $436.52 |
Where West Virginia sits
The same service costs 4.0 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
$324
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.