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 $120.23 Median $169.82 Typical High $194.98 | Professional | None | $120.23 | $169.82 | $194.98 |
CareSource Setting Professional Modifier None Typical Low $147.91 Median $147.91 Typical High $147.91 | Professional | None | $147.91 | $147.91 | $147.91 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $190.55 Typical High $354.81 | Facility | None | $34.67 | $190.55 | $354.81 |
Cigna Setting Professional Modifier None Typical Low $131.83 Median $199.53 Typical High $524.81 | Professional | None | $131.83 | $199.53 | $524.81 |
Highmark BCBS Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $245.47 | Professional | None | $245.47 | $245.47 | $245.47 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $1,148.15 | Facility | None | $100.00 | $131.83 | $1,148.15 |
United Setting Professional Modifier None Typical Low $112.20 Median $186.21 Typical High $436.52 | Professional | None | $112.20 | $186.21 | $436.52 |
7 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 $60.26 Median $64.57 Typical High $93.33 | Professional | 52 · Reduced service | $60.26 | $64.57 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $26.30 Typical High $38.02 | Professional | 53 · Discontinued | $23.99 | $26.30 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $97.72 Typical High $141.25 | Professional | 54 · Surgery only | $91.20 | $97.72 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $19.50 Typical High $28.18 | Professional | 55 · Aftercare only | $18.20 | $19.50 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $13.18 Typical High $18.62 | Professional | 56 · Pre-op care only | $12.02 | $13.18 | $18.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $91.20 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $85.11 | $91.20 | $131.83 |
Highmark BCBS Setting Facility Modifier XU · Unusual separate service Typical Low $812.83 Median $812.83 Typical High $812.83 | Facility | XU · Unusual separate service | $812.83 | $812.83 | $812.83 |
Where West Virginia sits
The same service costs 3.5 times more in Alaska than in Maryland. 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· 39th of 51
$186
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.