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 Professional Modifier None Typical Low $48.98 Median $89.13 Typical High $89.13 | Professional | None | $48.98 | $89.13 | $89.13 |
CareSource Setting Facility Modifier None Typical Low $95.50 Median $95.50 Typical High $95.50 | Facility | None | $95.50 | $95.50 | $95.50 |
CareSource Setting Professional Modifier None Typical Low $102.33 Median $144.54 Typical High $239.88 | Professional | None | $102.33 | $144.54 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $97.72 Median $97.72 Typical High $223.87 | Facility | None | $97.72 | $97.72 | $223.87 |
Cigna Setting Professional Modifier None Typical Low $70.79 Median $70.79 Typical High $812.83 | Professional | None | $70.79 | $70.79 | $812.83 |
Highmark BCBS Setting Facility Modifier None Typical Low $194.98 Median $194.98 Typical High $194.98 | Facility | None | $194.98 | $194.98 | $194.98 |
United Setting Facility Modifier None Typical Low $79.43 Median $89.13 Typical High $169.82 | Facility | None | $79.43 | $89.13 | $169.82 |
United Setting Professional Modifier None Typical Low $79.43 Median $97.72 Typical High $190.55 | Professional | None | $79.43 | $97.72 | $190.55 |
5 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 $42.66 Median $44.67 Typical High $44.67 | Professional | 52 · Reduced service | $42.66 | $44.67 | $44.67 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $17.78 Typical High $17.78 | Professional | 53 · Discontinued | $16.98 | $17.78 | $17.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $13.18 Typical High $13.18 | Professional | 55 · Aftercare only | $12.88 | $13.18 | $13.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $8.91 Typical High $8.91 | Professional | 56 · Pre-op care only | $8.51 | $8.91 | $8.91 |
Highmark BCBS Setting Professional Modifier KX · Policy requirements met Typical Low $120.23 Median $120.23 Typical High $173.78 | Professional | KX · Policy requirements met | $120.23 | $120.23 | $173.78 |
Where West Virginia sits
The same service costs 2.8 times more in Hawaii 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· 42nd of 51
$89.13
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.