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 $53.70 Median $4,073.80 Typical High $10,000.00 | Facility | None | $53.70 | $4,073.80 | $10,000.00 |
Aetna Setting Professional Modifier None Typical Low $45.71 Median $165.96 Typical High $239.88 | Professional | None | $45.71 | $165.96 | $239.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $40.74 Median $48.98 Typical High $67.61 | Professional | None | $40.74 | $48.98 | $67.61 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $61.66 Median $74.13 Typical High $100.00 | Professional | 50 · Both sides | $61.66 | $74.13 | $100.00 |
CareFirst Setting Professional Modifier None Typical Low $42.66 Median $46.77 Typical High $61.66 | Professional | None | $42.66 | $46.77 | $61.66 |
Cigna Setting Professional Modifier None Typical Low $42.66 Median $154.88 Typical High $323.59 | Professional | None | $42.66 | $154.88 | $323.59 |
Kaiser Permanente Setting Professional Modifier None Typical Low $218.78 Median $257.04 Typical High $323.59 | Professional | None | $218.78 | $257.04 | $323.59 |
Medcost Setting Professional Modifier None Typical Low $234.42 Median $295.12 Typical High $426.58 | Professional | None | $234.42 | $295.12 | $426.58 |
Medcost Setting Facility Modifier None Typical Low $58.88 Median $89.13 Typical High $323.59 | Facility | None | $58.88 | $89.13 | $323.59 |
Medcost Setting Professional Modifier None Typical Low $70.79 Median $181.97 Typical High $204.17 | Professional | None | $70.79 | $181.97 | $204.17 |
Sentara Setting Facility Modifier None Typical Low $39.81 Median $89.13 Typical High $10,232.93 | Facility | None | $39.81 | $89.13 | $10,232.93 |
Sentara Setting Professional Modifier None Typical Low $158.49 Median $239.88 Typical High $524.81 | Professional | None | $158.49 | $239.88 | $524.81 |
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 $40.74 Median $120.23 Typical High $338.84 | Professional | None | $40.74 | $120.23 | $338.84 |
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 $22.91 Median $36.31 Typical High $117.49 | Professional | 52 · Reduced service | $22.91 | $36.31 | $117.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.12 Median $14.45 Typical High $47.86 | Professional | 53 · Discontinued | $9.12 | $14.45 | $47.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $33.88 Median $53.70 Typical High $177.83 | Professional | 54 · Surgery only | $33.88 | $53.70 | $177.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.76 Median $10.72 Typical High $35.48 | Professional | 55 · Aftercare only | $6.76 | $10.72 | $35.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.57 Median $7.24 Typical High $23.99 | Professional | 56 · Pre-op care only | $4.57 | $7.24 | $23.99 |
Where Virginia sits
The same service costs 5.8 times more in Washington than in Virginia. 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· 51st of 51
$57.54
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.