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 $83.18 Median $107.15 Typical High $123.03 | Professional | None | $83.18 | $107.15 | $123.03 |
CareSource Setting Professional Modifier None Typical Low $97.72 Median $97.72 Typical High $97.72 | Professional | None | $97.72 | $97.72 | $97.72 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $144.54 Typical High $218.78 | Facility | None | $34.67 | $144.54 | $218.78 |
Cigna Setting Professional Modifier None Typical Low $95.50 Median $173.78 Typical High $891.25 | Professional | None | $95.50 | $173.78 | $891.25 |
Highmark BCBS Setting Facility Modifier None Typical Low $194.98 Median $194.98 Typical High $1,445.44 | Facility | None | $194.98 | $194.98 | $1,445.44 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $691.83 | Facility | None | $100.00 | $131.83 | $691.83 |
United Setting Professional Modifier None Typical Low $74.13 Median $114.82 Typical High $269.15 | Professional | None | $74.13 | $114.82 | $269.15 |
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 $41.69 Median $47.86 Typical High $58.88 | Professional | 52 · Reduced service | $41.69 | $47.86 | $58.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $19.05 Typical High $23.44 | Professional | 53 · Discontinued | $16.60 | $19.05 | $23.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $70.79 Typical High $89.13 | Professional | 54 · Surgery only | $63.10 | $70.79 | $89.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $14.13 Typical High $17.78 | Professional | 55 · Aftercare only | $12.59 | $14.13 | $17.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $9.55 Typical High $11.75 | Professional | 56 · Pre-op care only | $8.32 | $9.55 | $11.75 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $58.88 Median $66.07 Typical High $83.18 | Professional | 78 · Unplanned return to OR | $58.88 | $66.07 | $83.18 |
Where West Virginia sits
The same service costs 3.3 times more in Alaska than in Pennsylvania. 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
$129
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.