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 $181.97 Median $199.53 Typical High $239.88 | Professional | None | $181.97 | $199.53 | $239.88 |
CareSource Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $218.78 | Professional | None | $218.78 | $218.78 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $331.13 Typical High $371.54 | Facility | None | $34.67 | $331.13 | $371.54 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $316.23 Typical High $575.44 | Professional | None | $208.93 | $316.23 | $575.44 |
Highmark BCBS Setting Facility Modifier None Typical Low $194.98 Median $194.98 Typical High $194.98 | Facility | None | $194.98 | $194.98 | $194.98 |
Highmark BCBS Setting Professional Modifier None Typical Low $316.23 Median $446.68 Typical High $446.68 | Professional | None | $316.23 | $446.68 | $446.68 |
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 $141.25 Median $223.87 Typical High $407.38 | Professional | None | $141.25 | $223.87 | $407.38 |
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 $91.20 Median $100.00 Typical High $100.00 | Professional | 52 · Reduced service | $91.20 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $36.31 Median $39.81 Typical High $39.81 | Professional | 53 · Discontinued | $36.31 | $39.81 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $151.36 Typical High $151.36 | Professional | 54 · Surgery only | $138.04 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $30.20 Typical High $30.20 | Professional | 55 · Aftercare only | $27.54 | $30.20 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $19.95 Typical High $19.95 | Professional | 56 · Pre-op care only | $18.20 | $19.95 | $19.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $128.82 Median $141.25 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $128.82 | $141.25 | $141.25 |
Where West Virginia sits
The same service costs 4.8 times more in Alaska than in Florida. 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
$245
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.