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 $177.83 Median $234.42 Typical High $263.03 | Facility | None | $177.83 | $234.42 | $263.03 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $234.42 Typical High $316.23 | Professional | None | $162.18 | $234.42 | $316.23 |
CareSource Setting Professional Modifier None Typical Low $190.55 Median $190.55 Typical High $190.55 | Professional | None | $190.55 | $190.55 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $257.04 Median $398.11 Typical High $2,290.87 | Facility | None | $257.04 | $398.11 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $363.08 Typical High $1,621.81 | Professional | None | $204.17 | $363.08 | $1,621.81 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,041.74 Median $5,888.44 Typical High $10,715.19 | Facility | None | $2,041.74 | $5,888.44 | $10,715.19 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $5,011.87 | Facility | None | $426.58 | $660.69 | $5,011.87 |
United Setting Professional Modifier None Typical Low $154.88 Median $288.40 Typical High $741.31 | Professional | None | $154.88 | $288.40 | $741.31 |
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 $81.28 Median $93.33 Typical High $120.23 | Professional | 52 · Reduced service | $81.28 | $93.33 | $120.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $38.02 Typical High $48.98 | Professional | 53 · Discontinued | $32.36 | $38.02 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $120.23 Median $141.25 Typical High $181.97 | Professional | 54 · Surgery only | $120.23 | $141.25 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $28.18 Typical High $36.31 | Professional | 55 · Aftercare only | $24.55 | $28.18 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $18.62 Typical High $24.55 | Professional | 56 · Pre-op care only | $16.22 | $18.62 | $24.55 |
Where West Virginia sits
The same service costs 3.1 times more in Alaska than in New York. 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· 42nd of 51
$282
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.