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 $2.09 Median $6.61 Typical High $6.61 | Facility | None | $2.09 | $6.61 | $6.61 |
Aetna Setting Professional Modifier None Typical Low $1.91 Median $3.98 Typical High $7.08 | Professional | None | $1.91 | $3.98 | $7.08 |
CareSource Setting Professional Modifier None Typical Low $2.24 Median $5.75 Typical High $6.92 | Professional | None | $2.24 | $5.75 | $6.92 |
Cigna Setting Facility Modifier None Typical Low $10.00 Median $10.00 Typical High $34.67 | Facility | None | $10.00 | $10.00 | $34.67 |
Cigna Setting Professional Modifier None Typical Low $2.00 Median $6.17 Typical High $14.45 | Professional | None | $2.00 | $6.17 | $14.45 |
Highmark BCBS Setting Facility Modifier None Typical Low $69.18 Median $69.18 Typical High $69.18 | Facility | None | $69.18 | $69.18 | $69.18 |
Highmark BCBS Setting Professional Modifier None Typical Low $3.55 Median $8.51 Typical High $13.80 | Professional | None | $3.55 | $8.51 | $13.80 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $457.09 | Facility | None | $100.00 | $131.83 | $457.09 |
United Setting Professional Modifier None Typical Low $2.34 Median $8.13 Typical High $16.60 | Professional | None | $2.34 | $8.13 | $16.60 |
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 $0.95 Median $1.00 Typical High $2.95 | Professional | 52 · Reduced service | $0.95 | $1.00 | $2.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.38 Median $0.40 Typical High $1.20 | Professional | 53 · Discontinued | $0.38 | $0.40 | $1.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1.45 Median $1.48 Typical High $4.47 | Professional | 54 · Surgery only | $1.45 | $1.48 | $4.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.28 Median $0.30 Typical High $0.89 | Professional | 55 · Aftercare only | $0.28 | $0.30 | $0.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.19 Median $0.20 Typical High $0.60 | Professional | 56 · Pre-op care only | $0.19 | $0.20 | $0.60 |
Where West Virginia sits
The same service costs 3.0 times more in Alaska than in Nebraska. 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· 34th of 51
$6.17
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.