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 $151.36 Median $1,698.24 Typical High $4,073.80 | Facility | None | $151.36 | $1,698.24 | $4,073.80 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $398.11 Typical High $562.34 | Professional | None | $144.54 | $398.11 | $562.34 |
CareFirst Setting Professional Modifier None Typical Low $123.03 Median $134.90 Typical High $154.88 | Professional | None | $123.03 | $134.90 | $154.88 |
Cigna Setting Professional Modifier None Typical Low $131.83 Median $354.81 Typical High $616.60 | Professional | None | $131.83 | $354.81 | $616.60 |
Kaiser Permanente Setting Professional Modifier None Typical Low $457.09 Median $512.86 Typical High $1,047.13 | Professional | None | $457.09 | $512.86 | $1,047.13 |
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 $107.15 Median $346.74 Typical High $691.83 | Professional | None | $107.15 | $346.74 | $691.83 |
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 $72.44 Median $181.97 Typical High $275.42 | Professional | 52 · Reduced service | $72.44 | $181.97 | $275.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $29.51 Median $72.44 Typical High $112.20 | Professional | 53 · Discontinued | $29.51 | $72.44 | $112.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $269.15 Typical High $416.87 | Professional | 54 · Surgery only | $109.65 | $269.15 | $416.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $53.70 Typical High $83.18 | Professional | 55 · Aftercare only | $21.88 | $53.70 | $83.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $36.31 Typical High $56.23 | Professional | 56 · Pre-op care only | $14.45 | $36.31 | $56.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $102.33 Median $251.19 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $102.33 | $251.19 | $389.05 |
Where Washington, DC sits
The same service costs 4.5 times more in Wisconsin than in Washington, DC. 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· 51st of 51
$151
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.