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 $134.90 Median $4,365.16 Typical High $14,125.38 | Facility | None | $134.90 | $4,365.16 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $123.03 Median $134.90 Typical High $5,248.07 | Professional | None | $123.03 | $134.90 | $5,248.07 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,090.30 Median $3,715.35 Typical High $4,265.80 | Facility | None | $3,090.30 | $3,715.35 | $4,265.80 |
Anthem BCBS Setting Professional Modifier None Typical Low $109.65 Median $138.04 Typical High $162.18 | Professional | None | $109.65 | $138.04 | $162.18 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $17.78 Median $21.88 Typical High $25.70 | Professional | 80 · Assistant surgeon | $17.78 | $21.88 | $25.70 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $15.49 Median $18.62 Typical High $22.39 | Professional | AS · PA/NP assist | $15.49 | $18.62 | $22.39 |
CareFirst Setting Professional Modifier None Typical Low $138.04 Median $2,691.53 Typical High $4,365.16 | Professional | None | $138.04 | $2,691.53 | $4,365.16 |
Kaiser Permanente Setting Professional Modifier None Typical Low $100.00 Median $131.83 Typical High $147.91 | Professional | None | $100.00 | $131.83 | $147.91 |
Medcost Setting Facility Modifier None Typical Low $158.49 Median $158.49 Typical High $223.87 | Facility | None | $158.49 | $158.49 | $223.87 |
Sentara Setting Facility Modifier None Typical Low $125.89 Median $229.09 Typical High $10,232.93 | Facility | None | $125.89 | $229.09 | $10,232.93 |
Sentara Setting Professional Modifier None Typical Low $125.89 Median $229.09 Typical High $10,232.93 | Professional | None | $125.89 | $229.09 | $10,232.93 |
United Setting Facility Modifier None Typical Low $1,862.09 Median $3,548.13 Typical High $6,165.95 | Facility | None | $1,862.09 | $3,548.13 | $6,165.95 |
United Setting Professional Modifier None Typical Low $109.65 Median $194.98 Typical High $257.04 | Professional | None | $109.65 | $194.98 | $257.04 |
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 $58.88 Median $61.66 Typical High $67.61 | Professional | 52 · Reduced service | $58.88 | $61.66 | $67.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $24.55 Typical High $27.54 | Professional | 53 · Discontinued | $23.99 | $24.55 | $27.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $93.33 Typical High $102.33 | Professional | 54 · Surgery only | $89.13 | $93.33 | $102.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.78 Median $18.62 Typical High $20.42 | Professional | 55 · Aftercare only | $17.78 | $18.62 | $20.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.75 Median $12.30 Typical High $13.49 | Professional | 56 · Pre-op care only | $11.75 | $12.30 | $13.49 |
Where Virginia sits
The same service costs 37.2 times more in Oklahoma 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· 43rd of 51
$162
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.