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 $102.33 Median $138.04 Typical High $190.55 | Professional | None | $102.33 | $138.04 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $169.82 Median $398.11 Typical High $3,388.44 | Facility | None | $169.82 | $398.11 | $3,388.44 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $257.04 Typical High $416.87 | Professional | None | $134.90 | $257.04 | $416.87 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $6,456.54 | Facility | None | $426.58 | $660.69 | $6,456.54 |
United Setting Professional Modifier None Typical Low $83.18 Median $138.04 Typical High $251.19 | Professional | None | $83.18 | $138.04 | $251.19 |
7 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 $54.95 Median $69.18 Typical High $87.10 | Professional | 52 · Reduced service | $54.95 | $69.18 | $87.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $27.54 Typical High $34.67 | Professional | 53 · Discontinued | $21.88 | $27.54 | $34.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $102.33 Typical High $131.83 | Professional | 54 · Surgery only | $81.28 | $102.33 | $131.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $20.89 Typical High $26.30 | Professional | 55 · Aftercare only | $16.22 | $20.89 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $13.80 Typical High $17.38 | Professional | 56 · Pre-op care only | $10.96 | $13.80 | $17.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $75.86 Median $95.50 Typical High $123.03 | Professional | 78 · Unplanned return to OR | $75.86 | $95.50 | $123.03 |
Highmark BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $165.96 Typical High $165.96 | Professional | 78 · Unplanned return to OR | $165.96 | $165.96 | $165.96 |
Where West Virginia sits
The same service costs 4.8 times more in Alaska 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
$166
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.