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 $74.13 Median $97.72 Typical High $131.83 | Professional | None | $74.13 | $97.72 | $131.83 |
CareSource Setting Professional Modifier None Typical Low $91.20 Median $91.20 Typical High $91.20 | Professional | None | $91.20 | $91.20 | $91.20 |
Cigna Setting Facility Modifier None Typical Low $128.82 Median $398.11 Typical High $1,318.26 | Facility | None | $128.82 | $398.11 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $102.33 Median $204.17 Typical High $1,513.56 | Professional | None | $102.33 | $204.17 | $1,513.56 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,479.11 Median $1,479.11 Typical High $1,621.81 | Facility | None | $1,479.11 | $1,479.11 | $1,621.81 |
United Setting Facility Modifier None Typical Low $151.36 Median $436.52 Typical High $1,949.84 | Facility | None | $151.36 | $436.52 | $1,949.84 |
United Setting Professional Modifier None Typical Low $74.13 Median $151.36 Typical High $389.05 | Professional | None | $74.13 | $151.36 | $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 $37.15 Median $44.67 Typical High $66.07 | Professional | 52 · Reduced service | $37.15 | $44.67 | $66.07 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.79 Median $18.20 Typical High $26.30 | Professional | 53 · Discontinued | $14.79 | $18.20 | $26.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $56.23 Median $67.61 Typical High $100.00 | Professional | 54 · Surgery only | $56.23 | $67.61 | $100.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.22 Median $13.49 Typical High $19.95 | Professional | 55 · Aftercare only | $11.22 | $13.49 | $19.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.41 Median $9.12 Typical High $13.18 | Professional | 56 · Pre-op care only | $7.41 | $9.12 | $13.18 |
Where West Virginia sits
The same service costs 3.6 times more in Wisconsin than in Kentucky. 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· 37th of 51
$151
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.