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 $151.36 Median $3,801.89 Typical High $9,332.54 | Facility | None | $151.36 | $3,801.89 | $9,332.54 |
Aetna Setting Professional Modifier None Typical Low $95.50 Median $117.49 Typical High $186.21 | Professional | None | $95.50 | $117.49 | $186.21 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,737.80 Median $2,398.83 Typical High $2,951.21 | Facility | None | $1,737.80 | $2,398.83 | $2,951.21 |
Anthem BCBS Setting Professional Modifier None Typical Low $97.72 Median $117.49 Typical High $151.36 | Professional | None | $97.72 | $117.49 | $151.36 |
CareFirst Setting Professional Modifier None Typical Low $104.71 Median $117.49 Typical High $151.36 | Professional | None | $104.71 | $117.49 | $151.36 |
Cigna Setting Professional Modifier None Typical Low $100.00 Median $123.03 Typical High $194.98 | Professional | None | $100.00 | $123.03 | $194.98 |
Kaiser Permanente Setting Professional Modifier None Typical Low $89.13 Median $100.00 Typical High $131.83 | Professional | None | $89.13 | $100.00 | $131.83 |
Medcost Setting Professional Modifier None Typical Low $158.49 Median $199.53 Typical High $199.53 | Professional | None | $158.49 | $199.53 | $199.53 |
Medcost Setting Facility Modifier None Typical Low $151.36 Median $151.36 Typical High $199.53 | Facility | None | $151.36 | $151.36 | $199.53 |
Medcost Setting Professional Modifier None Typical Low $100.00 Median $144.54 Typical High $158.49 | Professional | None | $100.00 | $144.54 | $158.49 |
Sentara Setting Facility Modifier None Typical Low $93.33 Median $169.82 Typical High $10,232.93 | Facility | None | $93.33 | $169.82 | $10,232.93 |
Sentara Setting Professional Modifier None Typical Low $109.65 Median $141.25 Typical High $263.03 | Professional | None | $109.65 | $141.25 | $263.03 |
United Setting Facility Modifier None Typical Low $204.17 Median $1,023.29 Typical High $2,398.83 | Facility | None | $204.17 | $1,023.29 | $2,398.83 |
United Setting Professional Modifier None Typical Low $87.10 Median $134.90 Typical High $213.80 | Professional | None | $87.10 | $134.90 | $213.80 |
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 $48.98 Median $52.48 Typical High $60.26 | Professional | 52 · Reduced service | $48.98 | $52.48 | $60.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.50 Median $21.38 Typical High $23.99 | Professional | 53 · Discontinued | $19.50 | $21.38 | $23.99 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $72.44 Median $79.43 Typical High $91.20 | Professional | 54 · Surgery only | $72.44 | $79.43 | $91.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $15.85 Typical High $18.20 | Professional | 55 · Aftercare only | $14.79 | $15.85 | $18.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.77 Median $10.47 Typical High $12.02 | Professional | 56 · Pre-op care only | $9.77 | $10.47 | $12.02 |
Where Virginia sits
The same service costs 3.5 times more in Wisconsin 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.
Virginia· 35th of 51
$120
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.