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 $102.33 Median $144.54 Typical High $186.21 | Professional | None | $102.33 | $144.54 | $186.21 |
CareSource Setting Professional Modifier None Typical Low $123.03 Median $158.49 Typical High $190.55 | Professional | None | $123.03 | $158.49 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $162.18 | Facility | None | $34.67 | $34.67 | $162.18 |
Cigna Setting Professional Modifier None Typical Low $109.65 Median $173.78 Typical High $446.68 | Professional | None | $109.65 | $173.78 | $446.68 |
Highmark BCBS Setting Facility Modifier None Typical Low $389.05 Median $389.05 Typical High $389.05 | Facility | None | $389.05 | $389.05 | $389.05 |
Highmark BCBS Setting Professional Modifier None Typical Low $218.78 Median $234.42 Typical High $239.88 | Professional | None | $218.78 | $234.42 | $239.88 |
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 $95.50 Median $158.49 Typical High $363.08 | Professional | None | $95.50 | $158.49 | $363.08 |
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 $51.29 Median $54.95 Typical High $81.28 | Professional | 52 · Reduced service | $51.29 | $54.95 | $81.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $22.39 Typical High $32.36 | Professional | 53 · Discontinued | $20.42 | $22.39 | $32.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $83.18 Typical High $123.03 | Professional | 54 · Surgery only | $75.86 | $83.18 | $123.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $16.60 Typical High $24.55 | Professional | 55 · Aftercare only | $15.14 | $16.60 | $24.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $11.22 Typical High $16.22 | Professional | 56 · Pre-op care only | $10.23 | $11.22 | $16.22 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $70.79 Median $77.62 Typical High $114.82 | Professional | 78 · Unplanned return to OR | $70.79 | $77.62 | $114.82 |
Where West Virginia sits
The same service costs 3.4 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· 35th of 51
$162
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.