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 $1,412.54 Median $1,412.54 Typical High $1,412.54 | Facility | None | $1,412.54 | $1,412.54 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $104.71 Typical High $131.83 | Professional | None | $91.20 | $104.71 | $131.83 |
CareSource Setting Professional Modifier None Typical Low $107.15 Median $107.15 Typical High $107.15 | Professional | None | $107.15 | $107.15 | $107.15 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $151.36 Typical High $257.04 | Facility | None | $34.67 | $151.36 | $257.04 |
Cigna Setting Professional Modifier None Typical Low $109.65 Median $204.17 Typical High $1,778.28 | Professional | None | $109.65 | $204.17 | $1,778.28 |
Highmark BCBS Setting Facility Modifier None Typical Low $5,495.41 Median $5,495.41 Typical High $5,495.41 | Facility | None | $5,495.41 | $5,495.41 | $5,495.41 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $5,754.40 | Facility | None | $426.58 | $660.69 | $5,754.40 |
United Setting Professional Modifier None Typical Low $77.62 Median $120.23 Typical High $275.42 | Professional | None | $77.62 | $120.23 | $275.42 |
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 $45.71 Median $52.48 Typical High $67.61 | Professional | 52 · Reduced service | $45.71 | $52.48 | $67.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $20.89 Typical High $27.54 | Professional | 53 · Discontinued | $18.20 | $20.89 | $27.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $79.43 Typical High $102.33 | Professional | 54 · Surgery only | $69.18 | $79.43 | $102.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.80 Median $15.85 Typical High $20.42 | Professional | 55 · Aftercare only | $13.80 | $15.85 | $20.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $10.47 Typical High $13.80 | Professional | 56 · Pre-op care only | $9.12 | $10.47 | $13.80 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $64.57 Median $74.13 Typical High $95.50 | Professional | 78 · Unplanned return to OR | $64.57 | $74.13 | $95.50 |
Where West Virginia sits
The same service costs 3.5 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· 39th of 51
$138
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.