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 $141.25 Median $251.19 Typical High $251.19 | Facility | None | $141.25 | $251.19 | $251.19 |
Aetna Setting Professional Modifier None Typical Low $128.82 Median $218.78 Typical High $263.03 | Professional | None | $128.82 | $218.78 | $263.03 |
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 $223.87 Typical High $457.09 | Facility | None | $34.67 | $223.87 | $457.09 |
Cigna Setting Professional Modifier None Typical Low $186.21 Median $338.84 Typical High $676.08 | Professional | None | $186.21 | $338.84 | $676.08 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,318.26 Median $1,318.26 Typical High $2,951.21 | Facility | None | $1,318.26 | $1,318.26 | $2,951.21 |
Highmark BCBS Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $323.59 | Professional | None | $323.59 | $323.59 | $323.59 |
United Setting Facility Modifier None Typical Low $151.36 Median $436.52 Typical High $1,995.26 | Facility | None | $151.36 | $436.52 | $1,995.26 |
United Setting Professional Modifier None Typical Low $104.71 Median $199.53 Typical High $446.68 | Professional | None | $104.71 | $199.53 | $446.68 |
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 $64.57 Median $75.86 Typical High $112.20 | Professional | 52 · Reduced service | $64.57 | $75.86 | $112.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $30.20 Typical High $45.71 | Professional | 53 · Discontinued | $25.70 | $30.20 | $45.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $114.82 Typical High $169.82 | Professional | 54 · Surgery only | $95.50 | $114.82 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $22.91 Typical High $33.88 | Professional | 55 · Aftercare only | $19.05 | $22.91 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $15.14 Typical High $22.91 | Professional | 56 · Pre-op care only | $12.88 | $15.14 | $22.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $89.13 Median $107.15 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $89.13 | $107.15 | $158.49 |
Where West Virginia sits
The same service costs 3.6 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· 32nd of 51
$229
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.