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 $95.50 Median $128.82 Typical High $151.36 | Professional | None | $95.50 | $128.82 | $151.36 |
CareSource Setting Professional Modifier None Typical Low $117.49 Median $117.49 Typical High $117.49 | Professional | None | $117.49 | $117.49 | $117.49 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $154.88 Typical High $288.40 | Facility | None | $34.67 | $154.88 | $288.40 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $162.18 Typical High $416.87 | Professional | None | $104.71 | $162.18 | $416.87 |
Highmark BCBS Setting Professional Modifier None Typical Low $208.93 Median $208.93 Typical High $218.78 | Professional | None | $208.93 | $208.93 | $218.78 |
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 $91.20 Median $144.54 Typical High $346.74 | Professional | None | $91.20 | $144.54 | $346.74 |
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 $47.86 Median $52.48 Typical High $75.86 | Professional | 52 · Reduced service | $47.86 | $52.48 | $75.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $21.38 Typical High $30.20 | Professional | 53 · Discontinued | $19.05 | $21.38 | $30.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $72.44 Median $79.43 Typical High $112.20 | Professional | 54 · Surgery only | $72.44 | $79.43 | $112.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.45 Median $15.85 Typical High $22.39 | Professional | 55 · Aftercare only | $14.45 | $15.85 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $10.72 Typical High $15.14 | Professional | 56 · Pre-op care only | $9.55 | $10.72 | $15.14 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $67.61 Median $74.13 Typical High $104.71 | Professional | 78 · Unplanned return to OR | $67.61 | $74.13 | $104.71 |
Where West Virginia sits
The same service costs 3.5 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· 36th of 51
$151
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.