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 $190.55 Median $758.58 Typical High $758.58 | Facility | None | $190.55 | $758.58 | $758.58 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $501.19 Typical High $758.58 | Professional | None | $173.78 | $501.19 | $758.58 |
CareSource Setting Professional Modifier None Typical Low $194.98 Median $194.98 Typical High $194.98 | Professional | None | $194.98 | $194.98 | $194.98 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $263.03 Typical High $1,513.56 | Facility | None | $34.67 | $263.03 | $1,513.56 |
Cigna Setting Professional Modifier None Typical Low $229.09 Median $575.44 Typical High $1,445.44 | Professional | None | $229.09 | $575.44 | $1,445.44 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,818.38 Median $9,332.54 Typical High $19,952.62 | Facility | None | $2,818.38 | $9,332.54 | $19,952.62 |
Highmark BCBS Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $257.04 | Professional | None | $257.04 | $257.04 | $257.04 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $4,365.16 | Facility | None | $426.58 | $660.69 | $4,365.16 |
United Setting Professional Modifier None Typical Low $147.91 Median $446.68 Typical High $1,258.93 | Professional | None | $147.91 | $446.68 | $1,258.93 |
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 $87.10 Median $102.33 Typical High $363.08 | Professional | 52 · Reduced service | $87.10 | $102.33 | $363.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $40.74 Typical High $147.91 | Professional | 53 · Discontinued | $34.67 | $40.74 | $147.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $151.36 Typical High $549.54 | Professional | 54 · Surgery only | $128.82 | $151.36 | $549.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $30.20 Typical High $109.65 | Professional | 55 · Aftercare only | $25.70 | $30.20 | $109.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $19.05 Typical High $72.44 | Professional | 56 · Pre-op care only | $17.38 | $19.05 | $72.44 |
Where West Virginia sits
The same service costs 5.2 times more in Wisconsin than in Hawaii. 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· 43rd of 51
$513
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.