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 $162.18 Median $218.78 Typical High $245.47 | Professional | None | $162.18 | $218.78 | $245.47 |
CareSource Setting Professional Modifier None Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | None | $186.21 | $186.21 | $186.21 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $263.03 Typical High $416.87 | Facility | None | $34.67 | $263.03 | $416.87 |
Cigna Setting Professional Modifier None Typical Low $190.55 Median $331.13 Typical High $630.96 | Professional | None | $190.55 | $331.13 | $630.96 |
Highmark BCBS Setting Facility Modifier None Typical Low $7,079.46 Median $7,079.46 Typical High $7,079.46 | Facility | None | $7,079.46 | $7,079.46 | $7,079.46 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $9,332.54 | Facility | None | $426.58 | $660.69 | $9,332.54 |
United Setting Professional Modifier None Typical Low $128.82 Median $190.55 Typical High $354.81 | Professional | None | $128.82 | $190.55 | $354.81 |
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 $81.28 Median $97.72 Typical High $112.20 | Professional | 52 · Reduced service | $81.28 | $97.72 | $112.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $38.90 Typical High $44.67 | Professional | 53 · Discontinued | $32.36 | $38.90 | $44.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $120.23 Median $147.91 Typical High $169.82 | Professional | 54 · Surgery only | $120.23 | $147.91 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $29.51 Typical High $33.88 | Professional | 55 · Aftercare only | $23.99 | $29.51 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $19.50 Typical High $22.39 | Professional | 56 · Pre-op care only | $16.22 | $19.50 | $22.39 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $112.20 Median $138.04 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $112.20 | $138.04 | $158.49 |
Where West Virginia sits
The same service costs 3.8 times more in Alaska than in New Jersey. 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· 34th of 51
$224
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.