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 $263.03 Median $1,698.24 Typical High $4,073.80 | Facility | None | $263.03 | $1,698.24 | $4,073.80 |
Aetna Setting Professional Modifier None Typical Low $218.78 Median $263.03 Typical High $263.03 | Professional | None | $218.78 | $263.03 | $263.03 |
CareFirst Setting Professional Modifier None Typical Low $186.21 Median $281.84 Typical High $630.96 | Professional | None | $186.21 | $281.84 | $630.96 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $257.04 Typical High $724.44 | Professional | None | $218.78 | $257.04 | $724.44 |
Kaiser Permanente Setting Professional Modifier None Typical Low $295.12 Median $588.84 Typical High $602.56 | Professional | None | $295.12 | $588.84 | $602.56 |
United Setting Facility Modifier None Typical Low $537.03 Median $2,511.89 Typical High $27,542.29 | Facility | None | $537.03 | $2,511.89 | $27,542.29 |
United Setting Professional Modifier None Typical Low $173.78 Median $323.59 Typical High $724.44 | Professional | None | $173.78 | $323.59 | $724.44 |
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 $109.65 Median $131.83 Typical High $131.83 | Professional | 52 · Reduced service | $109.65 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $44.67 Median $52.48 Typical High $52.48 | Professional | 53 · Discontinued | $44.67 | $52.48 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $165.96 Median $194.98 Typical High $199.53 | Professional | 54 · Surgery only | $165.96 | $194.98 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.11 Median $38.90 Typical High $39.81 | Professional | 55 · Aftercare only | $33.11 | $38.90 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $26.30 Typical High $26.30 | Professional | 56 · Pre-op care only | $21.88 | $26.30 | $26.30 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $154.88 Median $181.97 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $154.88 | $181.97 | $186.21 |
Where Washington, DC sits
The same service costs 5.4 times more in Alaska than in Utah. 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· 35th of 51
$263
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.