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 $1,412.54 Median $1,412.54 Typical High $1,621.81 | Facility | None | $1,412.54 | $1,412.54 | $1,621.81 |
Aetna Setting Professional Modifier None Typical Low $114.82 Median $154.88 Typical High $190.55 | Professional | None | $114.82 | $154.88 | $190.55 |
CareSource Setting Professional Modifier None Typical Low $134.90 Median $177.83 Typical High $288.40 | Professional | None | $134.90 | $177.83 | $288.40 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $181.97 Typical High $346.74 | Facility | None | $34.67 | $181.97 | $346.74 |
Cigna Setting Professional Modifier None Typical Low $144.54 Median $281.84 Typical High $1,230.27 | Professional | None | $144.54 | $281.84 | $1,230.27 |
Highmark BCBS Setting Facility Modifier None Typical Low $891.25 Median $891.25 Typical High $891.25 | Facility | None | $891.25 | $891.25 | $891.25 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $1,096.48 | Facility | None | $100.00 | $131.83 | $1,096.48 |
United Setting Professional Modifier None Typical Low $109.65 Median $199.53 Typical High $478.63 | Professional | None | $109.65 | $199.53 | $478.63 |
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 $57.54 Median $67.61 Typical High $95.50 | Professional | 52 · Reduced service | $57.54 | $67.61 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $26.92 Typical High $38.02 | Professional | 53 · Discontinued | $22.91 | $26.92 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $100.00 Typical High $144.54 | Professional | 54 · Surgery only | $85.11 | $100.00 | $144.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $19.95 Typical High $28.84 | Professional | 55 · Aftercare only | $17.38 | $19.95 | $28.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $13.49 Typical High $19.05 | Professional | 56 · Pre-op care only | $11.48 | $13.49 | $19.05 |
Where West Virginia sits
The same service costs 3.0 times more in Wisconsin than in Maryland. 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
$200
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.