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 $79.43 Median $223.87 Typical High $338.84 | Professional | None | $79.43 | $223.87 | $338.84 |
CareFirst Setting Professional Modifier None Typical Low $79.43 Median $87.10 Typical High $87.10 | Professional | None | $79.43 | $87.10 | $87.10 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $223.87 Typical High $478.63 | Professional | None | $79.43 | $223.87 | $478.63 |
Kaiser Permanente Setting Professional Modifier None Typical Low $245.47 Median $389.05 Typical High $524.81 | Professional | None | $245.47 | $389.05 | $524.81 |
United Setting Professional Modifier None Typical Low $75.86 Median $213.80 Typical High $602.56 | Professional | None | $75.86 | $213.80 | $602.56 |
Wellpoint Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $549.54 | Professional | None | $223.87 | $223.87 | $549.54 |
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 $39.81 Median $114.82 Typical High $169.82 | Professional | 52 · Reduced service | $39.81 | $114.82 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.85 Median $45.71 Typical High $69.18 | Professional | 53 · Discontinued | $15.85 | $45.71 | $69.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $60.26 Median $173.78 Typical High $257.04 | Professional | 54 · Surgery only | $60.26 | $173.78 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.02 Median $34.67 Typical High $51.29 | Professional | 55 · Aftercare only | $12.02 | $34.67 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.94 Median $22.91 Typical High $33.88 | Professional | 56 · Pre-op care only | $7.94 | $22.91 | $33.88 |
Where Maryland sits
The same service costs 4.2 times more in Washington than in Virginia. 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· 47th of 51
$148
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.