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 $104.71 Median $162.18 Typical High $162.18 | Facility | None | $104.71 | $162.18 | $162.18 |
Aetna Setting Professional Modifier None Typical Low $95.50 Median $144.54 Typical High $204.17 | Professional | None | $95.50 | $144.54 | $204.17 |
CareSource Setting Professional Modifier None Typical Low $114.82 Median $141.25 Typical High $169.82 | Professional | None | $114.82 | $141.25 | $169.82 |
Cigna Setting Facility Modifier None Typical Low $165.96 Median $275.42 Typical High $1,318.26 | Facility | None | $165.96 | $275.42 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $229.09 Typical High $467.74 | Professional | None | $114.82 | $229.09 | $467.74 |
Highmark BCBS Setting Facility Modifier None Typical Low $416.87 Median $851.14 Typical High $3,548.13 | Facility | None | $416.87 | $851.14 | $3,548.13 |
Highmark BCBS Setting Professional Modifier None Typical Low $141.25 Median $147.91 Typical High $229.09 | Professional | None | $141.25 | $147.91 | $229.09 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $1,148.15 | Facility | None | $100.00 | $131.83 | $1,148.15 |
United Setting Professional Modifier None Typical Low $114.82 Median $186.21 Typical High $467.74 | Professional | None | $114.82 | $186.21 | $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 $46.77 Median $46.77 Typical High $72.44 | Professional | 52 · Reduced service | $46.77 | $46.77 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.62 Median $19.05 Typical High $29.51 | Professional | 53 · Discontinued | $18.62 | $19.05 | $29.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $70.79 Typical High $109.65 | Professional | 54 · Surgery only | $69.18 | $70.79 | $109.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.80 Median $14.13 Typical High $21.88 | Professional | 55 · Aftercare only | $13.80 | $14.13 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.33 Median $9.33 Typical High $14.45 | Professional | 56 · Pre-op care only | $9.33 | $9.33 | $14.45 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $64.57 Median $66.07 Typical High $102.33 | Professional | 78 · Unplanned return to OR | $64.57 | $66.07 | $102.33 |
Where West Virginia sits
The same service costs 3.2 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· 31st of 51
$174
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.