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 $30.20 Median $53.70 Typical High $53.70 | Professional | None | $30.20 | $53.70 | $53.70 |
CareSource Setting Facility Modifier None Typical Low $60.26 Median $60.26 Typical High $60.26 | Facility | None | $60.26 | $60.26 | $60.26 |
CareSource Setting Professional Modifier None Typical Low $64.57 Median $93.33 Typical High $151.36 | Professional | None | $64.57 | $93.33 | $151.36 |
Cigna Setting Facility Modifier None Typical Low $57.54 Median $57.54 Typical High $138.04 | Facility | None | $57.54 | $57.54 | $138.04 |
Cigna Setting Professional Modifier None Typical Low $42.66 Median $42.66 Typical High $501.19 | Professional | None | $42.66 | $42.66 | $501.19 |
Highmark BCBS Setting Facility Modifier None Typical Low $57.54 Median $57.54 Typical High $57.54 | Facility | None | $57.54 | $57.54 | $57.54 |
Highmark BCBS Setting Professional Modifier None Typical Low $104.71 Median $104.71 Typical High $104.71 | Professional | None | $104.71 | $104.71 | $104.71 |
United Setting Facility Modifier None Typical Low $43.65 Median $51.29 Typical High $104.71 | Facility | None | $43.65 | $51.29 | $104.71 |
United Setting Professional Modifier None Typical Low $47.86 Median $60.26 Typical High $117.49 | Professional | None | $47.86 | $60.26 | $117.49 |
4 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 $25.70 Median $26.92 Typical High $26.92 | Professional | 52 · Reduced service | $25.70 | $26.92 | $26.92 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $10.96 Typical High $10.96 | Professional | 53 · Discontinued | $10.47 | $10.96 | $10.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $8.13 Typical High $8.13 | Professional | 55 · Aftercare only | $7.76 | $8.13 | $8.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $5.37 Typical High $5.37 | Professional | 56 · Pre-op care only | $5.25 | $5.37 | $5.37 |
Where West Virginia sits
The same service costs 2.6 times more in Hawaii than in Delaware. 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
$53.70
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.