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 $100.00 Median $162.18 Typical High $162.18 | Facility | None | $100.00 | $162.18 | $162.18 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $134.90 Typical High $169.82 | Professional | None | $89.13 | $134.90 | $169.82 |
CareSource Setting Professional Modifier None Typical Low $107.15 Median $144.54 Typical High $173.78 | Professional | None | $107.15 | $144.54 | $173.78 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $151.36 Typical High $257.04 | Facility | None | $34.67 | $151.36 | $257.04 |
Cigna Setting Professional Modifier None Typical Low $95.50 Median $154.88 Typical High $389.05 | Professional | None | $95.50 | $154.88 | $389.05 |
Highmark BCBS Setting Facility Modifier None Typical Low $457.09 Median $2,570.40 Typical High $4,677.35 | Facility | None | $457.09 | $2,570.40 | $4,677.35 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $2,041.74 | Facility | None | $426.58 | $660.69 | $2,041.74 |
United Setting Professional Modifier None Typical Low $93.33 Median $169.82 Typical High $407.38 | Professional | None | $93.33 | $169.82 | $407.38 |
5 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 $44.67 Median $45.71 Typical High $74.13 | Professional | 52 · Reduced service | $44.67 | $45.71 | $74.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.78 Median $18.20 Typical High $29.51 | Professional | 53 · Discontinued | $17.78 | $18.20 | $29.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $67.61 Typical High $109.65 | Professional | 54 · Surgery only | $67.61 | $67.61 | $109.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $13.80 Typical High $22.39 | Professional | 55 · Aftercare only | $13.49 | $13.80 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $9.12 Typical High $14.79 | Professional | 56 · Pre-op care only | $8.91 | $9.12 | $14.79 |
Where West Virginia sits
The same service costs 3.2 times more in Alaska than in New Jersey. 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
$155
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.