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 $218.78 Median $239.88 Typical High $245.47 | Professional | None | $218.78 | $239.88 | $245.47 |
CareSource Setting Professional Modifier None Typical Low $263.03 Median $263.03 Typical High $263.03 | Professional | None | $263.03 | $263.03 | $263.03 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $371.54 Typical High $389.05 | Facility | None | $34.67 | $371.54 | $389.05 |
Cigna Setting Professional Modifier None Typical Low $257.04 Median $389.05 Typical High $691.83 | Professional | None | $257.04 | $389.05 | $691.83 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,202.26 Median $1,202.26 Typical High $1,202.26 | Facility | None | $1,202.26 | $1,202.26 | $1,202.26 |
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 $177.83 Median $281.84 Typical High $549.54 | Professional | None | $177.83 | $281.84 | $549.54 |
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 $109.65 Median $123.03 Typical High $123.03 | Professional | 52 · Reduced service | $109.65 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $48.98 Typical High $48.98 | Professional | 53 · Discontinued | $43.65 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $162.18 Median $181.97 Typical High $181.97 | Professional | 54 · Surgery only | $162.18 | $181.97 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $36.31 Typical High $36.31 | Professional | 55 · Aftercare only | $32.36 | $36.31 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $24.55 Typical High $24.55 | Professional | 56 · Pre-op care only | $21.88 | $24.55 | $24.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $151.36 Median $169.82 Typical High $169.82 | Professional | 78 · Unplanned return to OR | $151.36 | $169.82 | $169.82 |
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· 26th of 51
$316
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.