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 $4,786.30 | Facility | None | $151.36 | $1,698.24 | $4,786.30 |
Aetna Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $245.47 | Professional | None | $151.36 | $151.36 | $245.47 |
CareFirst Setting Professional Modifier None Typical Low $125.89 Median $144.54 Typical High $1,380.38 | Professional | None | $125.89 | $144.54 | $1,380.38 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $234.42 Typical High $588.84 | Professional | None | $147.91 | $234.42 | $588.84 |
Kaiser Permanente Setting Professional Modifier None Typical Low $234.42 Median $331.13 Typical High $524.81 | Professional | None | $234.42 | $331.13 | $524.81 |
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 $128.82 Median $281.84 Typical High $588.84 | Professional | None | $128.82 | $281.84 | $588.84 |
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 $75.86 Median $75.86 Typical High $123.03 | Professional | 52 · Reduced service | $75.86 | $75.86 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $30.20 Typical High $48.98 | Professional | 53 · Discontinued | $30.20 | $30.20 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $114.82 Typical High $186.21 | Professional | 54 · Surgery only | $112.20 | $114.82 | $186.21 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $22.91 Typical High $37.15 | Professional | 55 · Aftercare only | $22.39 | $22.91 | $37.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $15.14 Typical High $24.55 | Professional | 56 · Pre-op care only | $15.14 | $15.14 | $24.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $107.15 Typical High $173.78 | Professional | 78 · Unplanned return to OR | $104.71 | $107.15 | $173.78 |
Where Washington, DC sits
The same service costs 3.5 times more in Wisconsin than in Kentucky. 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· 26th of 51
$234
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.