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 $67.61 Median $104.71 Typical High $104.71 | Facility | None | $67.61 | $104.71 | $104.71 |
Aetna Setting Professional Modifier None Typical Low $61.66 Median $79.43 Typical High $104.71 | Professional | None | $61.66 | $79.43 | $104.71 |
CareSource Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | None | $75.86 | $75.86 | $75.86 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $104.71 Typical High $162.18 | Facility | None | $34.67 | $104.71 | $162.18 |
Cigna Setting Professional Modifier None Typical Low $81.28 Median $123.03 Typical High $660.69 | Professional | None | $81.28 | $123.03 | $660.69 |
Highmark BCBS Setting Facility Modifier None Typical Low $549.54 Median $5,011.87 Typical High $7,413.10 | Facility | None | $549.54 | $5,011.87 | $7,413.10 |
United Setting Facility Modifier None Typical Low $151.36 Median $436.52 Typical High $2,570.40 | Facility | None | $151.36 | $436.52 | $2,570.40 |
United Setting Professional Modifier None Typical Low $54.95 Median $95.50 Typical High $208.93 | Professional | None | $54.95 | $95.50 | $208.93 |
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 $30.90 Median $37.15 Typical High $50.12 | Professional | 52 · Reduced service | $30.90 | $37.15 | $50.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.30 Median $14.79 Typical High $19.95 | Professional | 53 · Discontinued | $12.30 | $14.79 | $19.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $46.77 Median $56.23 Typical High $74.13 | Professional | 54 · Surgery only | $46.77 | $56.23 | $74.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.33 Median $11.22 Typical High $14.79 | Professional | 55 · Aftercare only | $9.33 | $11.22 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.17 Median $7.41 Typical High $10.00 | Professional | 56 · Pre-op care only | $6.17 | $7.41 | $10.00 |
Where West Virginia sits
The same service costs 3.6 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· 41st of 51
$100
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.