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 $275.42 Median $323.59 Typical High $1,412.54 | Facility | None | $275.42 | $323.59 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $275.42 Median $288.40 Typical High $371.54 | Professional | None | $275.42 | $288.40 | $371.54 |
CareSource Setting Professional Modifier None Typical Low $331.13 Median $331.13 Typical High $331.13 | Professional | None | $331.13 | $331.13 | $331.13 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $371.54 Typical High $512.86 | Facility | None | $34.67 | $371.54 | $512.86 |
Cigna Setting Professional Modifier None Typical Low $295.12 Median $446.68 Typical High $776.25 | Professional | None | $295.12 | $446.68 | $776.25 |
Highmark BCBS Setting Facility Modifier None Typical Low $194.98 Median $478.63 Typical High $977.24 | Facility | None | $194.98 | $478.63 | $977.24 |
Highmark BCBS Setting Professional Modifier None Typical Low $416.87 Median $489.78 Typical High $724.44 | Professional | None | $416.87 | $489.78 | $724.44 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $691.83 | Facility | None | $100.00 | $131.83 | $691.83 |
United Setting Professional Modifier None Typical Low $194.98 Median $257.04 Typical High $537.03 | Professional | None | $194.98 | $257.04 | $537.03 |
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 $138.04 Median $144.54 Typical High $144.54 | Professional | 52 · Reduced service | $138.04 | $144.54 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $54.95 Median $57.54 Typical High $57.54 | Professional | 53 · Discontinued | $54.95 | $57.54 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $204.17 Median $213.80 Typical High $213.80 | Professional | 54 · Surgery only | $204.17 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $40.74 Median $42.66 Typical High $42.66 | Professional | 55 · Aftercare only | $40.74 | $42.66 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $27.54 Median $28.84 Typical High $28.84 | Professional | 56 · Pre-op care only | $27.54 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $190.55 Median $199.53 Typical High $199.53 | Professional | 78 · Unplanned return to OR | $190.55 | $199.53 | $199.53 |
Where West Virginia sits
The same service costs 5.6 times more in Alaska than in Texas. 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· 32nd 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.