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 $831.76 Median $1,000.00 Typical High $1,000.00 | Facility | None | $831.76 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier None Typical Low $758.58 Median $851.14 Typical High $1,000.00 | Professional | None | $758.58 | $851.14 | $1,000.00 |
CareSource Setting Professional Modifier None Typical Low $912.01 Median $912.01 Typical High $912.01 | Professional | None | $912.01 | $912.01 | $912.01 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $1,230.27 Typical High $3,090.30 | Facility | None | $602.56 | $1,230.27 | $3,090.30 |
Cigna Setting Professional Modifier None Typical Low $794.33 Median $977.24 Typical High $2,691.53 | Professional | None | $794.33 | $977.24 | $2,691.53 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,570.40 Median $6,309.57 Typical High $23,988.33 | Facility | None | $2,570.40 | $6,309.57 | $23,988.33 |
Highmark BCBS Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,380.38 | Professional | None | $1,258.93 | $1,258.93 | $1,380.38 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $5,754.40 | Facility | None | $426.58 | $660.69 | $5,754.40 |
United Setting Professional Modifier None Typical Low $741.31 Median $1,096.48 Typical High $2,238.72 | Professional | None | $741.31 | $1,096.48 | $2,238.72 |
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 $380.19 Median $416.87 Typical High $457.09 | Professional | 52 · Reduced service | $380.19 | $416.87 | $457.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $151.36 Median $165.96 Typical High $181.97 | Professional | 53 · Discontinued | $151.36 | $165.96 | $181.97 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $562.34 Median $616.60 Typical High $676.08 | Professional | 54 · Surgery only | $562.34 | $616.60 | $676.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $112.20 Median $123.03 Typical High $138.04 | Professional | 55 · Aftercare only | $112.20 | $123.03 | $138.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $83.18 Typical High $91.20 | Professional | 56 · Pre-op care only | $75.86 | $83.18 | $91.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $524.81 Median $575.44 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $524.81 | $575.44 | $630.96 |
Where West Virginia sits
The same service costs 4.5 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· 38th of 51
$977
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.