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 $218.78 Median $380.19 Typical High $1,621.81 | Facility | None | $218.78 | $380.19 | $1,621.81 |
Aetna Setting Professional Modifier None Typical Low $199.53 Median $275.42 Typical High $398.11 | Professional | None | $199.53 | $275.42 | $398.11 |
CareSource Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $245.47 | Professional | None | $245.47 | $245.47 | $245.47 |
Cigna Setting Facility Modifier None Typical Low $331.13 Median $537.03 Typical High $1,659.59 | Facility | None | $331.13 | $537.03 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $234.42 Median $489.78 Typical High $933.25 | Professional | None | $234.42 | $489.78 | $933.25 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,187.76 Median $2,187.76 Typical High $2,187.76 | Facility | None | $2,187.76 | $2,187.76 | $2,187.76 |
Highmark BCBS Setting Professional Modifier None Typical Low $467.74 Median $467.74 Typical High $467.74 | Professional | None | $467.74 | $467.74 | $467.74 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $2,041.74 | Facility | None | $100.00 | $131.83 | $2,041.74 |
United Setting Professional Modifier None Typical Low $181.97 Median $309.03 Typical High $707.95 | Professional | None | $181.97 | $309.03 | $707.95 |
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 $100.00 Median $107.15 Typical High $173.78 | Professional | 52 · Reduced service | $100.00 | $107.15 | $173.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $42.66 Typical High $69.18 | Professional | 53 · Discontinued | $39.81 | $42.66 | $69.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $151.36 Median $162.18 Typical High $263.03 | Professional | 54 · Surgery only | $151.36 | $162.18 | $263.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.20 Median $32.36 Typical High $52.48 | Professional | 55 · Aftercare only | $30.20 | $32.36 | $52.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $21.38 Typical High $34.67 | Professional | 56 · Pre-op care only | $19.95 | $21.38 | $34.67 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $141.25 Median $151.36 Typical High $245.47 | Professional | 78 · Unplanned return to OR | $141.25 | $151.36 | $245.47 |
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· 37th of 51
$331
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.