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 $104.71 Median $151.36 Typical High $151.36 | Facility | None | $104.71 | $151.36 | $151.36 |
Aetna Setting Professional Modifier None Typical Low $95.50 Median $128.82 Typical High $151.36 | Professional | None | $95.50 | $128.82 | $151.36 |
CareSource Setting Professional Modifier None Typical Low $114.82 Median $138.04 Typical High $229.09 | Professional | None | $114.82 | $138.04 | $229.09 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $158.49 Typical High $218.78 | Facility | None | $34.67 | $158.49 | $218.78 |
Cigna Setting Professional Modifier None Typical Low $123.03 Median $181.97 Typical High $891.25 | Professional | None | $123.03 | $181.97 | $891.25 |
Highmark BCBS Setting Facility Modifier None Typical Low $630.96 Median $758.58 Typical High $15,135.61 | Facility | None | $630.96 | $758.58 | $15,135.61 |
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 $87.10 Median $147.91 Typical High $323.59 | Professional | None | $87.10 | $147.91 | $323.59 |
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 $47.86 Median $56.23 Typical High $72.44 | Professional | 52 · Reduced service | $47.86 | $56.23 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $22.91 Typical High $29.51 | Professional | 53 · Discontinued | $19.05 | $22.91 | $29.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $70.79 Median $85.11 Typical High $109.65 | Professional | 54 · Surgery only | $70.79 | $85.11 | $109.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.13 Median $16.98 Typical High $21.88 | Professional | 55 · Aftercare only | $14.13 | $16.98 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $11.48 Typical High $14.79 | Professional | 56 · Pre-op care only | $9.55 | $11.48 | $14.79 |
Where West Virginia sits
The same service costs 3.2 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
$148
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.