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 $104.71 Median $109.65 Typical High $151.36 | Professional | None | $104.71 | $109.65 | $151.36 |
CareSource Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $128.82 | Professional | None | $128.82 | $128.82 | $128.82 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $181.97 Typical High $309.03 | Facility | None | $34.67 | $181.97 | $309.03 |
Cigna Setting Professional Modifier None Typical Low $128.82 Median $194.98 Typical High $851.14 | Professional | None | $128.82 | $194.98 | $851.14 |
Highmark BCBS Setting Facility Modifier None Typical Low $13,803.84 Median $13,803.84 Typical High $13,803.84 | Facility | None | $13,803.84 | $13,803.84 | $13,803.84 |
United Setting Facility Modifier None Typical Low $1,202.26 Median $1,479.11 Typical High $9,120.11 | Facility | None | $1,202.26 | $1,479.11 | $9,120.11 |
United Setting Professional Modifier None Typical Low $85.11 Median $128.82 Typical High $263.03 | Professional | None | $85.11 | $128.82 | $263.03 |
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 $52.48 Median $57.54 Typical High $75.86 | Professional | 52 · Reduced service | $52.48 | $57.54 | $75.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $22.91 Typical High $30.20 | Professional | 53 · Discontinued | $20.89 | $22.91 | $30.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $85.11 Typical High $112.20 | Professional | 54 · Surgery only | $77.62 | $85.11 | $112.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $16.98 Typical High $22.39 | Professional | 55 · Aftercare only | $15.49 | $16.98 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $11.48 Typical High $15.14 | Professional | 56 · Pre-op care only | $10.47 | $11.48 | $15.14 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $72.44 Median $79.43 Typical High $104.71 | Professional | 78 · Unplanned return to OR | $72.44 | $79.43 | $104.71 |
Where West Virginia sits
The same service costs 3.7 times more in Alaska 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· 40th 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.