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 $194.98 Median $1,698.24 Typical High $4,786.30 | Facility | None | $194.98 | $1,698.24 | $4,786.30 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $257.04 Typical High $645.65 | Professional | None | $194.98 | $257.04 | $645.65 |
CareFirst Setting Professional Modifier None Typical Low $229.09 Median $257.04 Typical High $2,089.30 | Professional | None | $229.09 | $257.04 | $2,089.30 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $309.03 Typical High $794.33 | Professional | None | $218.78 | $309.03 | $794.33 |
Kaiser Permanente Setting Professional Modifier None Typical Low $316.23 Median $338.84 Typical High $691.83 | Professional | None | $316.23 | $338.84 | $691.83 |
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 $213.80 Median $371.54 Typical High $794.33 | Professional | None | $213.80 | $371.54 | $794.33 |
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 $97.72 Median $123.03 Typical High $128.82 | Professional | 52 · Reduced service | $97.72 | $123.03 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $50.12 Typical High $51.29 | Professional | 53 · Discontinued | $38.90 | $50.12 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $186.21 Typical High $190.55 | Professional | 54 · Surgery only | $147.91 | $186.21 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $37.15 Typical High $38.02 | Professional | 55 · Aftercare only | $29.51 | $37.15 | $38.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $25.12 Typical High $25.70 | Professional | 56 · Pre-op care only | $19.50 | $25.12 | $25.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $173.78 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $138.04 | $173.78 | $177.83 |
Where Washington, DC sits
The same service costs 4.0 times more in Alaska than in New York. 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· 48th of 51
$288
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.