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 $1,230.27 Median $1,230.27 Typical High $1,412.54 | Facility | None | $1,230.27 | $1,230.27 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $64.57 Median $83.18 Typical High $93.33 | Professional | None | $64.57 | $83.18 | $93.33 |
CareSource Setting Professional Modifier None Typical Low $79.43 Median $79.43 Typical High $79.43 | Professional | None | $79.43 | $79.43 | $79.43 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $102.33 | Facility | None | $34.67 | $34.67 | $102.33 |
Cigna Setting Professional Modifier None Typical Low $70.79 Median $97.72 Typical High $245.47 | Professional | None | $70.79 | $97.72 | $245.47 |
Highmark BCBS Setting Facility Modifier None Typical Low $537.03 Median $537.03 Typical High $537.03 | Facility | None | $537.03 | $537.03 | $537.03 |
Highmark BCBS Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | None | $151.36 | $151.36 | $151.36 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $562.34 | Facility | None | $100.00 | $131.83 | $562.34 |
United Setting Professional Modifier None Typical Low $58.88 Median $93.33 Typical High $199.53 | Professional | None | $58.88 | $93.33 | $199.53 |
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 $32.36 Median $35.48 Typical High $45.71 | Professional | 52 · Reduced service | $32.36 | $35.48 | $45.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.88 Median $14.45 Typical High $18.20 | Professional | 53 · Discontinued | $12.88 | $14.45 | $18.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $48.98 Median $53.70 Typical High $67.61 | Professional | 54 · Surgery only | $48.98 | $53.70 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $10.72 Typical High $13.49 | Professional | 55 · Aftercare only | $9.77 | $10.72 | $13.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.46 Median $7.08 Typical High $9.12 | Professional | 56 · Pre-op care only | $6.46 | $7.08 | $9.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $45.71 Median $50.12 Typical High $63.10 | Professional | 78 · Unplanned return to OR | $45.71 | $50.12 | $63.10 |
Where West Virginia sits
The same service costs 3.8 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· 38th of 51
$93.33
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.