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 $776.25 Median $870.96 Typical High $1,000.00 | Professional | None | $776.25 | $870.96 | $1,000.00 |
CareSource Setting Professional Modifier None Typical Low $933.25 Median $933.25 Typical High $933.25 | Professional | None | $933.25 | $933.25 | $933.25 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,258.93 Typical High $3,090.30 | Facility | None | $537.03 | $1,258.93 | $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 $7,943.28 Median $7,943.28 Typical High $7,943.28 | Facility | None | $7,943.28 | $7,943.28 | $7,943.28 |
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 $707.95 Median $1,023.29 Typical High $2,137.96 | Professional | None | $707.95 | $1,023.29 | $2,137.96 |
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 $389.05 Median $426.58 Typical High $457.09 | Professional | 52 · Reduced service | $389.05 | $426.58 | $457.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $169.82 Typical High $181.97 | Professional | 53 · Discontinued | $154.88 | $169.82 | $181.97 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $645.65 Typical High $691.83 | Professional | 54 · Surgery only | $588.84 | $645.65 | $691.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $117.49 Median $128.82 Typical High $138.04 | Professional | 55 · Aftercare only | $117.49 | $128.82 | $138.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $77.62 Median $85.11 Typical High $91.20 | Professional | 56 · Pre-op care only | $77.62 | $85.11 | $91.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $602.56 Typical High $645.65 | Professional | 78 · Unplanned return to OR | $549.54 | $602.56 | $645.65 |
Where West Virginia sits
The same service costs 4.4 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· 36th 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.