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 $48.98 Median $4,365.16 Typical High $14,125.38 | Facility | None | $48.98 | $4,365.16 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $45.71 Median $48.98 Typical High $3,235.94 | Professional | None | $45.71 | $48.98 | $3,235.94 |
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 $36.31 Median $43.65 Typical High $52.48 | Professional | None | $36.31 | $43.65 | $52.48 |
CareFirst Setting Professional Modifier None Typical Low $37.15 Median $41.69 Typical High $5,128.61 | Professional | None | $37.15 | $41.69 | $5,128.61 |
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 $38.02 Median $48.98 Typical High $72.44 | Professional | None | $38.02 | $48.98 | $72.44 |
Kaiser Permanente Setting Professional Modifier None Typical Low $32.36 Median $37.15 Typical High $47.86 | Professional | None | $32.36 | $37.15 | $47.86 |
Medcost Setting Professional Modifier None Typical Low $53.70 Median $67.61 Typical High $67.61 | Professional | None | $53.70 | $67.61 | $67.61 |
Medcost Setting Facility Modifier None Typical Low $45.71 Median $54.95 Typical High $74.13 | Facility | None | $45.71 | $54.95 | $74.13 |
Medcost Setting Professional Modifier None Typical Low $51.29 Median $51.29 Typical High $51.29 | Professional | None | $51.29 | $51.29 | $51.29 |
Sentara Setting Facility Modifier None Typical Low $36.31 Median $208.93 Typical High $2,454.71 | Facility | None | $36.31 | $208.93 | $2,454.71 |
Sentara Setting Professional Modifier None Typical Low $37.15 Median $53.70 Typical High $1,258.93 | Professional | None | $37.15 | $53.70 | $1,258.93 |
United Setting Facility Modifier None Typical Low $100.00 Median $660.69 Typical High $2,089.30 | Facility | None | $100.00 | $660.69 | $2,089.30 |
United Setting Professional Modifier None Typical Low $34.67 Median $53.70 Typical High $81.28 | Professional | None | $34.67 | $53.70 | $81.28 |
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 $22.91 Typical High $24.55 | Professional | 52 · Reduced service | $22.91 | $22.91 | $24.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.12 Median $9.12 Typical High $9.77 | Professional | 53 · Discontinued | $9.12 | $9.12 | $9.77 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $33.88 Median $33.88 Typical High $36.31 | Professional | 54 · Surgery only | $33.88 | $33.88 | $36.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.76 Median $6.76 Typical High $7.41 | Professional | 55 · Aftercare only | $6.76 | $6.76 | $7.41 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.57 Median $4.57 Typical High $4.90 | Professional | 56 · Pre-op care only | $4.57 | $4.57 | $4.90 |
Where Virginia sits
The same service costs 9.3 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· 48th of 51
$48.98
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.