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 $154.88 Typical High $154.88 | Facility | None | $125.89 | $154.88 | $154.88 |
Aetna Setting Professional Modifier None Typical Low $114.82 Median $141.25 Typical High $165.96 | Professional | None | $114.82 | $141.25 | $165.96 |
CareSource Setting Professional Modifier None Typical Low $144.54 Median $144.54 Typical High $239.88 | Professional | None | $144.54 | $144.54 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $190.55 Typical High $208.93 | Facility | None | $34.67 | $190.55 | $208.93 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $239.88 Typical High $416.87 | Professional | None | $138.04 | $239.88 | $416.87 |
Highmark BCBS Setting Facility Modifier None Typical Low $239.88 Median $588.84 Typical High $1,288.25 | Facility | None | $239.88 | $588.84 | $1,288.25 |
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 $102.33 Median $165.96 Typical High $363.08 | Professional | None | $102.33 | $165.96 | $363.08 |
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 $57.54 Median $69.18 Typical High $70.79 | Professional | 52 · Reduced service | $57.54 | $69.18 | $70.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $27.54 Typical High $28.18 | Professional | 53 · Discontinued | $22.91 | $27.54 | $28.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $104.71 Typical High $107.15 | Professional | 54 · Surgery only | $87.10 | $104.71 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $20.89 Typical High $21.38 | Professional | 55 · Aftercare only | $17.38 | $20.89 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $13.80 Typical High $14.13 | Professional | 56 · Pre-op care only | $11.48 | $13.80 | $14.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $81.28 Median $97.72 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $81.28 | $97.72 | $100.00 |
Where West Virginia sits
The same service costs 3.9 times more in Alaska than in Florida. 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· 26th 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.