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 $218.78 Median $234.42 Typical High $239.88 | Professional | None | $218.78 | $234.42 | $239.88 |
CareFirst Setting Professional Modifier None Typical Low $257.04 Median $288.40 Typical High $288.40 | Professional | None | $257.04 | $288.40 | $288.40 |
Kaiser Permanente Setting Professional Modifier None Typical Low $208.93 Median $245.47 Typical High $416.87 | Professional | None | $208.93 | $245.47 | $416.87 |
United Setting Facility Modifier None Typical Low $1,288.25 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,288.25 | $2,511.89 | $5,754.40 |
United Setting Professional Modifier None Typical Low $128.82 Median $263.03 Typical High $575.44 | Professional | None | $128.82 | $263.03 | $575.44 |
Wellpoint Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $323.59 | Professional | None | $177.83 | $177.83 | $323.59 |
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 $109.65 Median $117.49 Typical High $120.23 | Professional | 52 · Reduced service | $109.65 | $117.49 | $120.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $44.67 Median $46.77 Typical High $48.98 | Professional | 53 · Discontinued | $44.67 | $46.77 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $165.96 Median $177.83 Typical High $181.97 | Professional | 54 · Surgery only | $165.96 | $177.83 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.11 Median $35.48 Typical High $36.31 | Professional | 55 · Aftercare only | $33.11 | $35.48 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $23.44 Typical High $23.99 | Professional | 56 · Pre-op care only | $21.88 | $23.44 | $23.99 |
Where Maryland sits
The same service costs 17.8 times more in Tennessee 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.
Maryland· 33rd of 51
$288
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.