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 $72.44 Median $102.33 Typical High $213.80 | Professional | None | $72.44 | $102.33 | $213.80 |
CareSource Setting Professional Modifier None Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | None | $83.18 | $83.18 | $83.18 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $112.20 | Facility | None | $34.67 | $34.67 | $112.20 |
Cigna Setting Professional Modifier None Typical Low $95.50 Median $223.87 Typical High $562.34 | Professional | None | $95.50 | $223.87 | $562.34 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,454.71 Median $2,454.71 Typical High $5,248.07 | Facility | None | $2,454.71 | $2,454.71 | $5,248.07 |
United Setting Facility Modifier None Typical Low $457.09 Median $457.09 Typical High $457.09 | Facility | None | $457.09 | $457.09 | $457.09 |
United Setting Professional Modifier None Typical Low $69.18 Median $158.49 Typical High $389.05 | Professional | None | $69.18 | $158.49 | $389.05 |
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 $36.31 Median $42.66 Typical High $83.18 | Professional | 52 · Reduced service | $36.31 | $42.66 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.45 Median $16.98 Typical High $33.11 | Professional | 53 · Discontinued | $14.45 | $16.98 | $33.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $54.95 Median $63.10 Typical High $123.03 | Professional | 54 · Surgery only | $54.95 | $63.10 | $123.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.96 Median $12.88 Typical High $24.55 | Professional | 55 · Aftercare only | $10.96 | $12.88 | $24.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.24 Median $8.51 Typical High $16.60 | Professional | 56 · Pre-op care only | $7.24 | $8.51 | $16.60 |
Where West Virginia sits
The same service costs 2.7 times more in Wisconsin 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· 35th of 51
$166
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.