How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $31.62 Median $1,288.25 Typical High $8,317.64 | Facility | None | $31.62 | $1,288.25 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $21.38 Median $58.88 Typical High $107.15 | Professional | None | $21.38 | $58.88 | $107.15 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,698.24 Median $2,398.83 Typical High $2,951.21 | Facility | None | $1,698.24 | $2,398.83 | $2,951.21 |
Anthem BCBS Setting Professional Modifier None Typical Low $20.89 Median $66.07 Typical High $100.00 | Professional | None | $20.89 | $66.07 | $100.00 |
CareFirst Setting Professional Modifier None Typical Low $16.60 Median $18.62 Typical High $21.88 | Professional | None | $16.60 | $18.62 | $21.88 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $50.12 Typical High $1,230.27 | Facility | None | $50.12 | $50.12 | $1,230.27 |
Cigna Setting Professional Modifier None Typical Low $20.42 Median $56.23 Typical High $89.13 | Professional | None | $20.42 | $56.23 | $89.13 |
Kaiser Permanente Setting Professional Modifier None Typical Low $74.13 Median $97.72 Typical High $117.49 | Professional | None | $74.13 | $97.72 | $117.49 |
Medcost Setting Professional Modifier None Typical Low $67.61 Median $67.61 Typical High $81.28 | Professional | None | $67.61 | $67.61 | $81.28 |
Medcost Setting Facility Modifier None Typical Low $25.70 Median $44.67 Typical High $123.03 | Facility | None | $25.70 | $44.67 | $123.03 |
Medcost Setting Professional Modifier None Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | None | $109.65 | $109.65 | $109.65 |
Sentara Setting Facility Modifier None Typical Low $23.99 Median $281.84 Typical High $2,454.71 | Facility | None | $23.99 | $281.84 | $2,454.71 |
Sentara Setting Professional Modifier None Typical Low $36.31 Median $77.62 Typical High $1,071.52 | Professional | None | $36.31 | $77.62 | $1,071.52 |
United Setting Facility Modifier None Typical Low $100.00 Median $660.69 Typical High $2,041.74 | Facility | None | $100.00 | $660.69 | $2,041.74 |
United Setting Professional Modifier None Typical Low $21.38 Median $48.98 Typical High $97.72 | Professional | None | $21.38 | $48.98 | $97.72 |
5 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 $10.72 Median $22.91 Typical High $43.65 | Professional | 52 · Reduced service | $10.72 | $22.91 | $43.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.27 Median $9.12 Typical High $17.38 | Professional | 53 · Discontinued | $4.27 | $9.12 | $17.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $15.85 Median $33.88 Typical High $64.57 | Professional | 54 · Surgery only | $15.85 | $33.88 | $64.57 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.16 Median $6.92 Typical High $13.18 | Professional | 55 · Aftercare only | $3.16 | $6.92 | $13.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.14 Median $4.90 Typical High $8.71 | Professional | 56 · Pre-op care only | $2.14 | $4.90 | $8.71 |
Where Virginia sits
The same service costs 3.4 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.
Virginia· 28th of 51
$66.07
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.