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 $562,341.33 Median $562,341.33 Typical High $1,148,153.62 | Facility | None | $562,341.33 | $562,341.33 | $1,148,153.62 |
Aetna Setting Professional Modifier None Typical Low $562,341.33 Median $588,843.66 Typical High $588,843.66 | Professional | None | $562,341.33 | $588,843.66 | $588,843.66 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $281,838.29 Median $295,120.92 Typical High $295,120.92 | Professional | 52 · Reduced service | $281,838.29 | $295,120.92 | $295,120.92 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $112,201.85 Median $117,489.76 Typical High $117,489.76 | Professional | 53 · Discontinued | $112,201.85 | $117,489.76 | $117,489.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $85,113.80 Median $87,096.36 Typical High $87,096.36 | Professional | 55 · Aftercare only | $85,113.80 | $87,096.36 | $87,096.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $56,234.13 Median $58,884.37 Typical High $58,884.37 | Professional | 56 · Pre-op care only | $56,234.13 | $58,884.37 | $58,884.37 |
CareSource Setting Professional Modifier None Typical Low $562,341.33 Median $562,341.33 Typical High $562,341.33 | Professional | None | $562,341.33 | $562,341.33 | $562,341.33 |
United Setting Facility Modifier None Typical Low $575,439.94 Median $575,439.94 Typical High $575,439.94 | Facility | None | $575,439.94 | $575,439.94 | $575,439.94 |
United Setting Professional Modifier None Typical Low $831,763.77 Median $831,763.77 Typical High $831,763.77 | Professional | None | $831,763.77 | $831,763.77 | $831,763.77 |
1 more rate 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 |
|---|---|---|---|---|---|
Highmark BCBS Setting Facility Modifier JZ · No drug discarded Typical Low $616,595.00 Median $616,595.00 Typical High $616,595.00 | Facility | JZ · No drug discarded | $616,595.00 | $616,595.00 | $616,595.00 |
Where West Virginia sits
The same service costs 1.7 times more in Texas than in Minnesota. 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· 23rd of 51
$588,844
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.