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 $186.21 Median $1,698.24 Typical High $4,073.80 | Facility | None | $186.21 | $1,698.24 | $4,073.80 |
Aetna Setting Professional Modifier None Typical Low $177.83 Median $190.55 Typical High $263.03 | Professional | None | $177.83 | $190.55 | $263.03 |
CareFirst Setting Professional Modifier None Typical Low $147.91 Median $165.96 Typical High $190.55 | Professional | None | $147.91 | $165.96 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $213.80 Typical High $338.84 | Professional | None | $158.49 | $213.80 | $338.84 |
Kaiser Permanente Setting Professional Modifier None Typical Low $208.93 Median $234.42 Typical High $436.52 | Professional | None | $208.93 | $234.42 | $436.52 |
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 $125.89 Median $190.55 Typical High $436.52 | Professional | None | $125.89 | $190.55 | $436.52 |
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 $89.13 Median $95.50 Typical High $131.83 | Professional | 52 · Reduced service | $89.13 | $95.50 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $38.02 Typical High $52.48 | Professional | 53 · Discontinued | $35.48 | $38.02 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $141.25 Typical High $199.53 | Professional | 54 · Surgery only | $134.90 | $141.25 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $28.18 Typical High $39.81 | Professional | 55 · Aftercare only | $26.92 | $28.18 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $19.05 Typical High $26.30 | Professional | 56 · Pre-op care only | $17.78 | $19.05 | $26.30 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $131.83 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $125.89 | $131.83 | $186.21 |
Where Washington, DC sits
The same service costs 4.2 times more in Alaska than in New Jersey. 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· 43rd of 51
$186
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.