How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $302.00 Median $323.59 Typical High $323.59 | Professional | None | $302.00 | $323.59 | $323.59 |
CareFirst Setting Professional Modifier None Typical Low $338.84 Median $380.19 Typical High $380.19 | Professional | None | $338.84 | $380.19 | $380.19 |
Cigna Setting Facility Modifier None Typical Low $371.54 Median $501.19 Typical High $776.25 | Facility | None | $371.54 | $501.19 | $776.25 |
Kaiser Permanente Setting Professional Modifier None Typical Low $323.59 Median $363.08 Typical High $691.83 | Professional | None | $323.59 | $363.08 | $691.83 |
United Setting Facility Modifier None Typical Low $208.93 Median $398.11 Typical High $1,047.13 | Facility | None | $208.93 | $398.11 | $1,047.13 |
United Setting Professional Modifier None Typical Low $138.04 Median $302.00 Typical High $616.60 | Professional | None | $138.04 | $302.00 | $616.60 |
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 $151.36 Median $162.18 Typical High $162.18 | Professional | 52 · Reduced service | $151.36 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $60.26 Median $64.57 Typical High $64.57 | Professional | 53 · Discontinued | $60.26 | $64.57 | $64.57 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $229.09 Median $245.47 Typical High $245.47 | Professional | 54 · Surgery only | $229.09 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $45.71 Median $48.98 Typical High $48.98 | Professional | 55 · Aftercare only | $45.71 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $30.20 Median $32.36 Typical High $32.36 | Professional | 56 · Pre-op care only | $30.20 | $32.36 | $32.36 |
Where Maryland sits
The same service costs 8.3 times more in Oklahoma than in Rhode Island. 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.
Maryland· 34th of 51
$372
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.