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 $162.18 Median $173.78 Typical High $177.83 | Professional | None | $162.18 | $173.78 | $177.83 |
CareFirst Setting Professional Modifier None Typical Low $181.97 Median $199.53 Typical High $199.53 | Professional | None | $181.97 | $199.53 | $199.53 |
Kaiser Permanente Setting Professional Modifier None Typical Low $154.88 Median $177.83 Typical High $309.03 | Professional | None | $154.88 | $177.83 | $309.03 |
United Setting Facility Modifier None Typical Low $407.38 Median $645.65 Typical High $1,380.38 | Facility | None | $407.38 | $645.65 | $1,380.38 |
United Setting Professional Modifier None Typical Low $128.82 Median $194.98 Typical High $426.58 | Professional | None | $128.82 | $194.98 | $426.58 |
Wellpoint Setting Professional Modifier None Typical Low $131.83 Median $131.83 Typical High $234.42 | Professional | None | $131.83 | $131.83 | $234.42 |
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 $81.28 Median $87.10 Typical High $89.13 | Professional | 52 · Reduced service | $81.28 | $87.10 | $89.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $34.67 Typical High $35.48 | Professional | 53 · Discontinued | $32.36 | $34.67 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $128.82 Typical High $134.90 | Professional | 54 · Surgery only | $123.03 | $128.82 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $26.30 Typical High $26.92 | Professional | 55 · Aftercare only | $24.55 | $26.30 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $17.38 Typical High $17.78 | Professional | 56 · Pre-op care only | $16.22 | $17.38 | $17.78 |
Where Maryland sits
The same service costs 17.4 times more in Oklahoma 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.
Maryland· 43rd of 51
$200
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.