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 $158.49 Median $257.04 Typical High $1,412.54 | Facility | None | $158.49 | $257.04 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $158.49 Median $218.78 Typical High $295.12 | Professional | None | $158.49 | $218.78 | $295.12 |
CareSource Setting Professional Modifier None Typical Low $190.55 Median $251.19 Typical High $302.00 | Professional | None | $190.55 | $251.19 | $302.00 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $263.03 Typical High $537.03 | Facility | None | $34.67 | $263.03 | $537.03 |
Cigna Setting Professional Modifier None Typical Low $181.97 Median $389.05 Typical High $676.08 | Professional | None | $181.97 | $389.05 | $676.08 |
Highmark BCBS Setting Facility Modifier None Typical Low $741.31 Median $954.99 Typical High $3,467.37 | Facility | None | $741.31 | $954.99 | $3,467.37 |
Highmark BCBS Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $389.05 | Professional | None | $218.78 | $218.78 | $389.05 |
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 $147.91 Median $245.47 Typical High $575.44 | Professional | None | $147.91 | $245.47 | $575.44 |
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 $77.62 Median $85.11 Typical High $128.82 | Professional | 52 · Reduced service | $77.62 | $85.11 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $31.62 Median $34.67 Typical High $51.29 | Professional | 53 · Discontinued | $31.62 | $34.67 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $117.49 Median $128.82 Typical High $194.98 | Professional | 54 · Surgery only | $117.49 | $128.82 | $194.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.44 Median $25.70 Typical High $38.90 | Professional | 55 · Aftercare only | $23.44 | $25.70 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.85 Median $16.98 Typical High $25.70 | Professional | 56 · Pre-op care only | $15.85 | $16.98 | $25.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $109.65 Median $120.23 Typical High $181.97 | Professional | 78 · Unplanned return to OR | $109.65 | $120.23 | $181.97 |
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· 33rd of 51
$257
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.