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 $27.54 Median $45.71 Typical High $45.71 | Facility | None | $27.54 | $45.71 | $45.71 |
Aetna Setting Professional Modifier None Typical Low $25.12 Median $33.88 Typical High $47.86 | Professional | None | $25.12 | $33.88 | $47.86 |
CareSource Setting Professional Modifier None Typical Low $28.84 Median $39.81 Typical High $66.07 | Professional | None | $28.84 | $39.81 | $66.07 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $39.81 | Facility | None | $34.67 | $34.67 | $39.81 |
Cigna Setting Professional Modifier None Typical Low $31.62 Median $67.61 Typical High $363.08 | Professional | None | $31.62 | $67.61 | $363.08 |
Highmark BCBS Setting Facility Modifier None Typical Low $208.93 Median $316.23 Typical High $616.60 | Facility | None | $208.93 | $316.23 | $616.60 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $457.09 | Facility | None | $100.00 | $131.83 | $457.09 |
United Setting Professional Modifier None Typical Low $23.44 Median $47.86 Typical High $144.54 | Professional | None | $23.44 | $47.86 | $144.54 |
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 $12.59 Median $14.45 Typical High $21.88 | Professional | 52 · Reduced service | $12.59 | $14.45 | $21.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.01 Median $5.75 Typical High $8.71 | Professional | 53 · Discontinued | $5.01 | $5.75 | $8.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $18.62 Median $21.38 Typical High $33.11 | Professional | 54 · Surgery only | $18.62 | $21.38 | $33.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.72 Median $4.27 Typical High $6.61 | Professional | 55 · Aftercare only | $3.72 | $4.27 | $6.61 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.51 Median $2.88 Typical High $4.37 | Professional | 56 · Pre-op care only | $2.51 | $2.88 | $4.37 |
Where West Virginia sits
The same service costs 3.4 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· 46th of 51
$45.71
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.