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 $186.21 Median $263.03 Typical High $263.03 | Facility | None | $186.21 | $263.03 | $263.03 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $190.55 Typical High $263.03 | Professional | None | $169.82 | $190.55 | $263.03 |
CareSource Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $218.78 | Professional | None | $218.78 | $218.78 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $295.12 Median $1,862.09 Typical High $4,677.35 | Facility | None | $295.12 | $1,862.09 | $4,677.35 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $281.84 Typical High $1,548.82 | Professional | None | $204.17 | $281.84 | $1,548.82 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,981.07 Median $4,168.69 Typical High $8,317.64 | Facility | None | $3,981.07 | $4,168.69 | $8,317.64 |
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 $151.36 Median $257.04 Typical High $524.81 | Professional | None | $151.36 | $257.04 | $524.81 |
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 $85.11 Median $100.00 Typical High $120.23 | Professional | 52 · Reduced service | $85.11 | $100.00 | $120.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $39.81 Typical High $47.86 | Professional | 53 · Discontinued | $33.88 | $39.81 | $47.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $125.89 Median $147.91 Typical High $177.83 | Professional | 54 · Surgery only | $125.89 | $147.91 | $177.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.12 Median $30.20 Typical High $36.31 | Professional | 55 · Aftercare only | $25.12 | $30.20 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $19.95 Typical High $23.99 | Professional | 56 · Pre-op care only | $16.98 | $19.95 | $23.99 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $117.49 Median $138.04 Typical High $165.96 | Professional | 78 · Unplanned return to OR | $117.49 | $138.04 | $165.96 |
Where West Virginia sits
The same service costs 9.5 times more in Oklahoma than in West Virginia. 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.
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.