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 $407.38 Median $3,388.44 Typical High $7,079.46 | Facility | None | $407.38 | $3,388.44 | $7,079.46 |
Aetna Setting Professional Modifier None Typical Low $407.38 Median $1,659.59 Typical High $5,011.87 | Professional | None | $407.38 | $1,659.59 | $5,011.87 |
CareFirst Setting Professional Modifier None Typical Low $389.05 Median $436.52 Typical High $4,570.88 | Professional | None | $389.05 | $436.52 | $4,570.88 |
Cigna Setting Professional Modifier None Typical Low $389.05 Median $1,122.02 Typical High $5,128.61 | Professional | None | $389.05 | $1,122.02 | $5,128.61 |
Kaiser Permanente Setting Professional Modifier None Typical Low $933.25 Median $2,041.74 Typical High $4,365.16 | Professional | None | $933.25 | $2,041.74 | $4,365.16 |
United Setting Facility Modifier None Typical Low $1,737.80 Median $7,943.28 Typical High $27,542.29 | Facility | None | $1,737.80 | $7,943.28 | $27,542.29 |
United Setting Professional Modifier None Typical Low $380.19 Median $1,122.02 Typical High $4,677.35 | Professional | None | $380.19 | $1,122.02 | $4,677.35 |
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 $204.17 Median $831.76 Typical High $1,000.00 | Professional | 52 · Reduced service | $204.17 | $831.76 | $1,000.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $331.13 Typical High $398.11 | Professional | 53 · Discontinued | $81.28 | $331.13 | $398.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $1,230.27 Typical High $1,479.11 | Professional | 54 · Surgery only | $309.03 | $1,230.27 | $1,479.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $251.19 Typical High $295.12 | Professional | 55 · Aftercare only | $61.66 | $251.19 | $295.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $165.96 Typical High $199.53 | Professional | 56 · Pre-op care only | $40.74 | $165.96 | $199.53 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $1,148.15 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $288.40 | $1,148.15 | $1,380.38 |
Where Washington, DC sits
The same service costs 5.2 times more in Oregon 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.
Washington, DC· 38th of 51
$1,122
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.