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 $213.80 Median $229.09 Typical High $229.09 | Facility | None | $213.80 | $229.09 | $229.09 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $208.93 Typical High $275.42 | Professional | None | $194.98 | $208.93 | $275.42 |
CareSource Setting Professional Modifier None Typical Low $204.17 Median $208.93 Typical High $338.84 | Professional | None | $204.17 | $208.93 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $354.81 Typical High $371.54 | Facility | None | $34.67 | $354.81 | $371.54 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $323.59 Typical High $588.84 | Professional | None | $218.78 | $323.59 | $588.84 |
Highmark BCBS Setting Facility Modifier None Typical Low $323.59 Median $562.34 Typical High $1,071.52 | Facility | None | $323.59 | $562.34 | $1,071.52 |
Highmark BCBS Setting Professional Modifier None Typical Low $295.12 Median $331.13 Typical High $501.19 | Professional | None | $295.12 | $331.13 | $501.19 |
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 $147.91 Median $223.87 Typical High $416.87 | Professional | None | $147.91 | $223.87 | $416.87 |
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 $97.72 Median $102.33 Typical High $102.33 | Professional | 52 · Reduced service | $97.72 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $41.69 Typical High $41.69 | Professional | 53 · Discontinued | $38.90 | $41.69 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $154.88 Typical High $154.88 | Professional | 54 · Surgery only | $147.91 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $30.90 Typical High $30.90 | Professional | 55 · Aftercare only | $29.51 | $30.90 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $20.89 Typical High $20.89 | Professional | 56 · Pre-op care only | $19.50 | $20.89 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $144.54 Typical High $144.54 | Professional | 78 · Unplanned return to OR | $138.04 | $144.54 | $144.54 |
Where West Virginia sits
The same service costs 5.1 times more in Alaska than in Utah. 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· 31st of 51
$257
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.