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 $134.90 Median $2,137.96 Typical High $6,606.93 | Facility | None | $134.90 | $2,137.96 | $6,606.93 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $134.90 Typical High $295.12 | Professional | None | $131.83 | $134.90 | $295.12 |
CareFirst Setting Professional Modifier None Typical Low $109.65 Median $120.23 Typical High $190.55 | Professional | None | $109.65 | $120.23 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $123.03 Typical High $316.23 | Professional | None | $117.49 | $123.03 | $316.23 |
Kaiser Permanente Setting Professional Modifier None Typical Low $104.71 Median $117.49 Typical High $275.42 | Professional | None | $104.71 | $117.49 | $275.42 |
United Setting Facility Modifier None Typical Low $1,288.25 Median $5,754.40 Typical High $27,542.29 | Facility | None | $1,288.25 | $5,754.40 | $27,542.29 |
United Setting Professional Modifier None Typical Low $173.78 Median $234.42 Typical High $363.08 | Professional | None | $173.78 | $234.42 | $363.08 |
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 $66.07 Median $67.61 Typical High $138.04 | Professional | 52 · Reduced service | $66.07 | $67.61 | $138.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $26.92 Typical High $54.95 | Professional | 53 · Discontinued | $26.30 | $26.92 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $102.33 Typical High $204.17 | Professional | 54 · Surgery only | $97.72 | $102.33 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $20.42 Typical High $40.74 | Professional | 55 · Aftercare only | $19.95 | $20.42 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $13.49 Typical High $27.54 | Professional | 56 · Pre-op care only | $13.18 | $13.49 | $27.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $95.50 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $91.20 | $95.50 | $190.55 |
Where Washington, DC sits
The same service costs 4.8 times more in Wisconsin 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.
Washington, DC· 49th of 51
$135
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.