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 $81.28 Median $104.71 Typical High $302.00 | Professional | None | $81.28 | $104.71 | $302.00 |
CareSource Setting Professional Modifier None Typical Low $93.33 Median $93.33 Typical High $93.33 | Professional | None | $93.33 | $93.33 | $93.33 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $125.89 | Facility | None | $34.67 | $34.67 | $125.89 |
Cigna Setting Professional Modifier None Typical Low $107.15 Median $302.00 Typical High $2,818.38 | Professional | None | $107.15 | $302.00 | $2,818.38 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,174.90 | Facility | None | $1,174.90 | $1,174.90 | $1,174.90 |
Highmark BCBS Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $138.04 | Professional | None | $138.04 | $138.04 | $138.04 |
United Setting Facility Modifier None Typical Low $457.09 Median $457.09 Typical High $457.09 | Facility | None | $457.09 | $457.09 | $457.09 |
United Setting Professional Modifier None Typical Low $77.62 Median $204.17 Typical High $501.19 | Professional | None | $77.62 | $204.17 | $501.19 |
5 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 $41.69 Median $43.65 Typical High $151.36 | Professional | 52 · Reduced service | $41.69 | $43.65 | $151.36 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $17.38 Typical High $60.26 | Professional | 53 · Discontinued | $16.60 | $17.38 | $60.26 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $66.07 Typical High $223.87 | Professional | 54 · Surgery only | $61.66 | $66.07 | $223.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $13.18 Typical High $44.67 | Professional | 55 · Aftercare only | $12.30 | $13.18 | $44.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $8.71 Typical High $30.20 | Professional | 56 · Pre-op care only | $8.32 | $8.71 | $30.20 |
Where West Virginia sits
The same service costs 4.2 times more in Washington than in Virginia. 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· 30th of 51
$234
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.