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 $1,230.27 Median $1,230.27 Typical High $1,412.54 | Facility | None | $1,230.27 | $1,230.27 | $1,412.54 |
Aetna Setting Professional Modifier None Typical Low $39.81 Median $69.18 Typical High $70.79 | Professional | None | $39.81 | $69.18 | $70.79 |
CareSource Setting Professional Modifier None Typical Low $50.12 Median $50.12 Typical High $50.12 | Professional | None | $50.12 | $50.12 | $50.12 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $69.18 Typical High $125.89 | Facility | None | $34.67 | $69.18 | $125.89 |
Cigna Setting Professional Modifier None Typical Low $60.26 Median $120.23 Typical High $371.54 | Professional | None | $60.26 | $120.23 | $371.54 |
United Setting Facility Modifier None Typical Low $151.36 Median $436.52 Typical High $1,949.84 | Facility | None | $151.36 | $436.52 | $1,949.84 |
United Setting Professional Modifier None Typical Low $35.48 Median $100.00 Typical High $239.88 | Professional | None | $35.48 | $100.00 | $239.88 |
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 $19.95 Median $34.67 Typical High $35.48 | Professional | 52 · Reduced service | $19.95 | $34.67 | $35.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $13.80 Typical High $14.45 | Professional | 53 · Discontinued | $7.94 | $13.80 | $14.45 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $29.51 Median $52.48 Typical High $53.70 | Professional | 54 · Surgery only | $29.51 | $52.48 | $53.70 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.03 Median $10.47 Typical High $10.72 | Professional | 55 · Aftercare only | $6.03 | $10.47 | $10.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.98 Median $6.92 Typical High $7.08 | Professional | 56 · Pre-op care only | $3.98 | $6.92 | $7.08 |
Highmark BCBS Setting Facility Modifier 59 · Distinct service Typical Low $3,019.95 Median $3,019.95 Typical High $3,019.95 | Facility | 59 · Distinct service | $3,019.95 | $3,019.95 | $3,019.95 |
Where West Virginia sits
The same service costs 3.2 times more in Alaska than in 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.
West Virginia· 29th of 51
$91.20
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.