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 $93.33 Median $131.83 Typical High $131.83 | Facility | None | $93.33 | $131.83 | $131.83 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $95.50 Typical High $131.83 | Professional | None | $85.11 | $95.50 | $131.83 |
CareSource Setting Professional Modifier None Typical Low $95.50 Median $95.50 Typical High $95.50 | Professional | None | $95.50 | $95.50 | $95.50 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $134.90 Typical High $199.53 | Facility | None | $34.67 | $134.90 | $199.53 |
Cigna Setting Professional Modifier None Typical Low $102.33 Median $181.97 Typical High $851.14 | Professional | None | $102.33 | $181.97 | $851.14 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,659.59 Median $1,659.59 Typical High $1,659.59 | Facility | None | $1,659.59 | $1,659.59 | $1,659.59 |
United Setting Facility Modifier None Typical Low $151.36 Median $436.52 Typical High $1,995.26 | Facility | None | $151.36 | $436.52 | $1,995.26 |
United Setting Professional Modifier None Typical Low $72.44 Median $125.89 Typical High $302.00 | Professional | None | $72.44 | $125.89 | $302.00 |
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 $42.66 Median $47.86 Typical High $60.26 | Professional | 52 · Reduced service | $42.66 | $47.86 | $60.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $19.05 Typical High $24.55 | Professional | 53 · Discontinued | $16.98 | $19.05 | $24.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $72.44 Typical High $91.20 | Professional | 54 · Surgery only | $63.10 | $72.44 | $91.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $14.45 Typical High $18.20 | Professional | 55 · Aftercare only | $12.88 | $14.45 | $18.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $9.55 Typical High $12.02 | Professional | 56 · Pre-op care only | $8.51 | $9.55 | $12.02 |
Where West Virginia sits
The same service costs 3.2 times more in Wisconsin than in Texas. 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· 35th of 51
$132
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.