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 $239.88 Median $1,698.24 Typical High $4,073.80 | Facility | None | $239.88 | $1,698.24 | $4,073.80 |
Aetna Setting Professional Modifier None Typical Low $239.88 Median $263.03 Typical High $363.08 | Professional | None | $239.88 | $263.03 | $363.08 |
CareFirst Setting Professional Modifier None Typical Low $194.98 Median $213.80 Typical High $851.14 | Professional | None | $194.98 | $213.80 | $851.14 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $331.13 Typical High $812.83 | Professional | None | $218.78 | $331.13 | $812.83 |
Kaiser Permanente Setting Professional Modifier None Typical Low $338.84 Median $354.81 Typical High $724.44 | Professional | None | $338.84 | $354.81 | $724.44 |
United Setting Facility Modifier None Typical Low $109.65 Median $549.54 Typical High $1,548.82 | Facility | None | $109.65 | $549.54 | $1,548.82 |
United Setting Professional Modifier None Typical Low $223.87 Median $478.63 Typical High $831.76 | Professional | None | $223.87 | $478.63 | $831.76 |
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 $120.23 Median $131.83 Typical High $181.97 | Professional | 52 · Reduced service | $120.23 | $131.83 | $181.97 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $47.86 Median $52.48 Typical High $72.44 | Professional | 53 · Discontinued | $47.86 | $52.48 | $72.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $177.83 Median $199.53 Typical High $269.15 | Professional | 54 · Surgery only | $177.83 | $199.53 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $39.81 Typical High $53.70 | Professional | 55 · Aftercare only | $35.48 | $39.81 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.99 Median $26.30 Typical High $36.31 | Professional | 56 · Pre-op care only | $23.99 | $26.30 | $36.31 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $186.21 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $165.96 | $186.21 | $251.19 |
Where Washington, DC sits
The same service costs 3.7 times more in Wisconsin than in Texas. 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· 33rd of 51
$347
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.