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 $125.89 Median $177.83 Typical High $263.03 | Facility | None | $125.89 | $177.83 | $263.03 |
Aetna Setting Professional Modifier None Typical Low $114.82 Median $138.04 Typical High $177.83 | Professional | None | $114.82 | $138.04 | $177.83 |
CareSource Setting Professional Modifier None Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | None | $141.25 | $141.25 | $141.25 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $194.98 Typical High $263.03 | Facility | None | $34.67 | $194.98 | $263.03 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $213.80 Typical High $1,023.29 | Professional | None | $147.91 | $213.80 | $1,023.29 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,148.15 Median $1,737.80 Typical High $3,630.78 | Facility | None | $1,148.15 | $1,737.80 | $3,630.78 |
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 $102.33 Median $177.83 Typical High $380.19 | Professional | None | $102.33 | $177.83 | $380.19 |
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 $57.54 Median $69.18 Typical High $85.11 | Professional | 52 · Reduced service | $57.54 | $69.18 | $85.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $27.54 Typical High $33.88 | Professional | 53 · Discontinued | $22.91 | $27.54 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $102.33 Typical High $128.82 | Professional | 54 · Surgery only | $85.11 | $102.33 | $128.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $20.89 Typical High $25.70 | Professional | 55 · Aftercare only | $16.98 | $20.89 | $25.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $13.80 Typical High $16.98 | Professional | 56 · Pre-op care only | $11.48 | $13.80 | $16.98 |
Where West Virginia sits
The same service costs 3.7 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· 39th of 51
$178
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.