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 $173.78 Median $302.00 Typical High $4,897.79 | Facility | None | $173.78 | $302.00 | $4,897.79 |
Aetna Setting Professional Modifier None Typical Low $147.91 Median $229.09 Typical High $309.03 | Professional | None | $147.91 | $229.09 | $309.03 |
CareSource Setting Professional Modifier None Typical Low $169.82 Median $169.82 Typical High $169.82 | Professional | None | $169.82 | $169.82 | $169.82 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $234.42 Typical High $562.34 | Facility | None | $34.67 | $234.42 | $562.34 |
Cigna Setting Professional Modifier None Typical Low $194.98 Median $407.38 Typical High $691.83 | Professional | None | $194.98 | $407.38 | $691.83 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,202.26 Median $1,949.84 Typical High $2,818.38 | Facility | None | $1,202.26 | $1,949.84 | $2,818.38 |
Highmark BCBS Setting Professional Modifier None Typical Low $151.36 Median $371.54 Typical High $416.87 | Professional | None | $151.36 | $371.54 | $416.87 |
United Setting Facility Modifier None Typical Low $426.58 Median $660.69 Typical High $2,754.23 | Facility | None | $426.58 | $660.69 | $2,754.23 |
United Setting Professional Modifier None Typical Low $120.23 Median $218.78 Typical High $446.68 | Professional | None | $120.23 | $218.78 | $446.68 |
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 $77.62 Median $97.72 Typical High $138.04 | Professional | 52 · Reduced service | $77.62 | $97.72 | $138.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $31.62 Median $38.90 Typical High $54.95 | Professional | 53 · Discontinued | $31.62 | $38.90 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $117.49 Median $147.91 Typical High $208.93 | Professional | 54 · Surgery only | $117.49 | $147.91 | $208.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.44 Median $29.51 Typical High $41.69 | Professional | 55 · Aftercare only | $23.44 | $29.51 | $41.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.85 Median $19.50 Typical High $27.54 | Professional | 56 · Pre-op care only | $15.85 | $19.50 | $27.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $109.65 Median $138.04 Typical High $194.98 | Professional | 78 · Unplanned return to OR | $109.65 | $138.04 | $194.98 |
Where West Virginia sits
The same service costs 3.8 times more in Wyoming 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· 41st of 51
$251
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.