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 $151.36 Median $363.08 Typical High $363.08 | Facility | None | $151.36 | $363.08 | $363.08 |
Aetna Setting Professional Modifier None Typical Low $138.04 Median $323.59 Typical High $363.08 | Professional | None | $138.04 | $323.59 | $363.08 |
CareSource Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
Cigna Setting Facility Modifier None Typical Low $239.88 Median $398.11 Typical High $1,995.26 | Facility | None | $239.88 | $398.11 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $199.53 Median $398.11 Typical High $954.99 | Professional | None | $199.53 | $398.11 | $954.99 |
Highmark BCBS Setting Facility Modifier None Typical Low $6,760.83 Median $6,760.83 Typical High $8,317.64 | Facility | None | $6,760.83 | $6,760.83 | $8,317.64 |
Highmark BCBS Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $851.14 | Professional | None | $323.59 | $323.59 | $851.14 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $4,570.88 | Facility | None | $426.58 | $660.69 | $4,570.88 |
United Setting Professional Modifier None Typical Low $114.82 Median $288.40 Typical High $758.58 | Professional | None | $114.82 | $288.40 | $758.58 |
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 $69.18 Median $83.18 Typical High $165.96 | Professional | 52 · Reduced service | $69.18 | $83.18 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $27.54 Median $33.11 Typical High $66.07 | Professional | 53 · Discontinued | $27.54 | $33.11 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $104.71 Median $123.03 Typical High $251.19 | Professional | 54 · Surgery only | $104.71 | $123.03 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.89 Median $24.55 Typical High $50.12 | Professional | 55 · Aftercare only | $20.89 | $24.55 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $16.60 Typical High $33.11 | Professional | 56 · Pre-op care only | $13.80 | $16.60 | $33.11 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $97.72 Median $114.82 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $97.72 | $114.82 | $234.42 |
Where West Virginia sits
The same service costs 4.0 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· 29th of 51
$331
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.