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 $89.13 Median $4,365.16 Typical High $14,125.38 | Facility | None | $89.13 | $4,365.16 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $89.13 Typical High $2,041.74 | Professional | None | $89.13 | $89.13 | $2,041.74 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,548.82 Median $3,890.45 Typical High $6,918.31 | Facility | None | $1,548.82 | $3,890.45 | $6,918.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $72.44 Median $87.10 Typical High $109.65 | Professional | None | $72.44 | $87.10 | $109.65 |
CareFirst Setting Professional Modifier None Typical Low $77.62 Median $87.10 Typical High $112.20 | Professional | None | $77.62 | $87.10 | $112.20 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $794.33 Typical High $5,495.41 | Facility | None | $501.19 | $794.33 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $104.71 Typical High $151.36 | Professional | None | $75.86 | $104.71 | $151.36 |
Kaiser Permanente Setting Professional Modifier None Typical Low $69.18 Median $79.43 Typical High $102.33 | Professional | None | $69.18 | $79.43 | $102.33 |
Medcost Setting Professional Modifier None Typical Low $141.25 Median $177.83 Typical High $177.83 | Professional | None | $141.25 | $177.83 | $177.83 |
Medcost Setting Facility Modifier None Typical Low $89.13 Median $131.83 Typical High $147.91 | Facility | None | $89.13 | $131.83 | $147.91 |
Medcost Setting Professional Modifier None Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | None | $123.03 | $123.03 | $123.03 |
Sentara Setting Facility Modifier None Typical Low $83.18 Median $912.01 Typical High $5,128.61 | Facility | None | $83.18 | $912.01 | $5,128.61 |
Sentara Setting Professional Modifier None Typical Low $83.18 Median $112.20 Typical High $1,288.25 | Professional | None | $83.18 | $112.20 | $1,288.25 |
United Setting Facility Modifier None Typical Low $436.52 Median $2,344.23 Typical High $6,309.57 | Facility | None | $436.52 | $2,344.23 | $6,309.57 |
United Setting Professional Modifier None Typical Low $67.61 Median $120.23 Typical High $165.96 | Professional | None | $67.61 | $120.23 | $165.96 |
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 $42.66 Median $44.67 Typical High $44.67 | Professional | 52 · Reduced service | $42.66 | $44.67 | $44.67 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $17.78 Typical High $17.78 | Professional | 53 · Discontinued | $16.98 | $17.78 | $17.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $64.57 Median $67.61 Typical High $67.61 | Professional | 54 · Surgery only | $64.57 | $67.61 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $13.49 Typical High $13.49 | Professional | 55 · Aftercare only | $12.88 | $13.49 | $13.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $8.91 Typical High $8.91 | Professional | 56 · Pre-op care only | $8.51 | $8.91 | $8.91 |
Where Virginia sits
The same service costs 6.5 times more in Tennessee 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· 45th of 51
$102
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.