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 $83.18 Median $120.23 Typical High $1,412.54 | Facility | None | $83.18 | $120.23 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $83.18 Median $102.33 Typical High $131.83 | Professional | None | $83.18 | $102.33 | $131.83 |
CareSource Setting Professional Modifier None Typical Low $104.71 Median $104.71 Typical High $104.71 | Professional | None | $104.71 | $104.71 | $104.71 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $144.54 Typical High $204.17 | Facility | None | $34.67 | $144.54 | $204.17 |
Cigna Setting Professional Modifier None Typical Low $109.65 Median $158.49 Typical High $776.25 | Professional | None | $109.65 | $158.49 | $776.25 |
Highmark BCBS Setting Facility Modifier None Typical Low $457.09 Median $457.09 Typical High $575.44 | Facility | None | $457.09 | $457.09 | $575.44 |
United Setting Facility Modifier None Typical Low $100.00 Median $131.83 Typical High $851.14 | Facility | None | $100.00 | $131.83 | $851.14 |
United Setting Professional Modifier None Typical Low $75.86 Median $128.82 Typical High $275.42 | Professional | None | $75.86 | $128.82 | $275.42 |
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 $41.69 Median $51.29 Typical High $64.57 | Professional | 52 · Reduced service | $41.69 | $51.29 | $64.57 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $20.42 Typical High $25.70 | Professional | 53 · Discontinued | $16.60 | $20.42 | $25.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $77.62 Typical High $95.50 | Professional | 54 · Surgery only | $63.10 | $77.62 | $95.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $15.49 Typical High $19.05 | Professional | 55 · Aftercare only | $12.59 | $15.49 | $19.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $10.23 Typical High $12.88 | Professional | 56 · Pre-op care only | $8.32 | $10.23 | $12.88 |
Where West Virginia sits
The same service costs 3.3 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· 43rd 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.