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 $45.71 Median $87.10 Typical High $87.10 | Facility | None | $45.71 | $87.10 | $87.10 |
Aetna Setting Professional Modifier None Typical Low $41.69 Median $79.43 Typical High $107.15 | Professional | None | $41.69 | $79.43 | $107.15 |
CareSource Setting Professional Modifier None Typical Low $79.43 Median $95.50 Typical High $131.83 | Professional | None | $79.43 | $95.50 | $131.83 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $67.61 | Facility | None | $34.67 | $34.67 | $67.61 |
Cigna Setting Professional Modifier None Typical Low $54.95 Median $131.83 Typical High $316.23 | Professional | None | $54.95 | $131.83 | $316.23 |
Highmark BCBS Setting Facility Modifier None Typical Low $363.08 Median $1,479.11 Typical High $8,511.38 | Facility | None | $363.08 | $1,479.11 | $8,511.38 |
United Setting Facility Modifier None Typical Low $457.09 Median $457.09 Typical High $1,949.84 | Facility | None | $457.09 | $457.09 | $1,949.84 |
United Setting Professional Modifier None Typical Low $35.48 Median $100.00 Typical High $213.80 | Professional | None | $35.48 | $100.00 | $213.80 |
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 $20.89 Median $38.90 Typical High $39.81 | Professional | 52 · Reduced service | $20.89 | $38.90 | $39.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.32 Median $15.49 Typical High $15.85 | Professional | 53 · Discontinued | $8.32 | $15.49 | $15.85 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $30.90 Median $57.54 Typical High $58.88 | Professional | 54 · Surgery only | $30.90 | $57.54 | $58.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.17 Median $11.48 Typical High $11.75 | Professional | 55 · Aftercare only | $6.17 | $11.48 | $11.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.17 Median $7.76 Typical High $7.94 | Professional | 56 · Pre-op care only | $4.17 | $7.76 | $7.94 |
Where West Virginia sits
The same service costs 2.5 times more in North Carolina than in Florida. 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
$87.10
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.