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 $213.80 Median $269.15 Typical High $323.59 | Professional | None | $213.80 | $269.15 | $323.59 |
CareSource Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $257.04 | Professional | None | $257.04 | $257.04 | $257.04 |
Cigna Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $1,318.26 | Facility | None | $338.84 | $524.81 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $229.09 Median $309.03 Typical High $831.76 | Professional | None | $229.09 | $309.03 | $831.76 |
Highmark BCBS Setting Facility Modifier None Typical Low $19,054.61 Median $19,054.61 Typical High $36,307.81 | Facility | None | $19,054.61 | $19,054.61 | $36,307.81 |
Highmark BCBS Setting Professional Modifier None Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | None | $416.87 | $416.87 | $416.87 |
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 $194.98 Median $302.00 Typical High $676.08 | Professional | None | $194.98 | $302.00 | $676.08 |
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 $107.15 Median $114.82 Typical High $144.54 | Professional | 52 · Reduced service | $107.15 | $114.82 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $42.66 Median $45.71 Typical High $57.54 | Professional | 53 · Discontinued | $42.66 | $45.71 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $169.82 Typical High $218.78 | Professional | 54 · Surgery only | $158.49 | $169.82 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $33.88 Typical High $43.65 | Professional | 55 · Aftercare only | $31.62 | $33.88 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.38 Median $22.91 Typical High $28.84 | Professional | 56 · Pre-op care only | $21.38 | $22.91 | $28.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $147.91 Median $158.49 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $147.91 | $158.49 | $204.17 |
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· 37th of 51
$302
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.