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 $100.00 Median $4,073.80 Typical High $10,000.00 | Facility | None | $100.00 | $4,073.80 | $10,000.00 |
Aetna Setting Professional Modifier None Typical Low $93.33 Median $316.23 Typical High $416.87 | Professional | None | $93.33 | $316.23 | $416.87 |
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 $83.18 Median $263.03 Typical High $407.38 | Professional | None | $83.18 | $263.03 | $407.38 |
CareFirst Setting Professional Modifier None Typical Low $81.28 Median $91.20 Typical High $107.15 | Professional | None | $81.28 | $91.20 | $107.15 |
Cigna Setting Facility Modifier None Typical Low $138.04 Median $309.03 Typical High $1,659.59 | Facility | None | $138.04 | $309.03 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $85.11 Median $218.78 Typical High $436.52 | Professional | None | $85.11 | $218.78 | $436.52 |
Kaiser Permanente Setting Professional Modifier None Typical Low $363.08 Median $436.52 Typical High $537.03 | Professional | None | $363.08 | $436.52 | $537.03 |
Medcost Setting Professional Modifier None Typical Low $851.14 Median $851.14 Typical High $851.14 | Professional | None | $851.14 | $851.14 | $851.14 |
Medcost Setting Facility Modifier None Typical Low $93.33 Median $154.88 Typical High $602.56 | Facility | None | $93.33 | $154.88 | $602.56 |
Medcost Setting Professional Modifier None Typical Low $295.12 Median $316.23 Typical High $446.68 | Professional | None | $295.12 | $316.23 | $446.68 |
Sentara Setting Facility Modifier None Typical Low $85.11 Median $380.19 Typical High $2,454.71 | Facility | None | $85.11 | $380.19 | $2,454.71 |
Sentara Setting Professional Modifier None Typical Low $338.84 Median $389.05 Typical High $562.34 | Professional | None | $338.84 | $389.05 | $562.34 |
United Setting Facility Modifier None Typical Low $100.00 Median $660.69 Typical High $2,041.74 | Facility | None | $100.00 | $660.69 | $2,041.74 |
United Setting Professional Modifier None Typical Low $72.44 Median $213.80 Typical High $512.86 | Professional | None | $72.44 | $213.80 | $512.86 |
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 $46.77 Median $87.10 Typical High $208.93 | Professional | 52 · Reduced service | $46.77 | $87.10 | $208.93 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $34.67 Typical High $83.18 | Professional | 53 · Discontinued | $19.05 | $34.67 | $83.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $70.79 Median $131.83 Typical High $316.23 | Professional | 54 · Surgery only | $70.79 | $131.83 | $316.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.13 Median $26.30 Typical High $63.10 | Professional | 55 · Aftercare only | $14.13 | $26.30 | $63.10 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.33 Median $17.38 Typical High $41.69 | Professional | 56 · Pre-op care only | $9.33 | $17.38 | $41.69 |
Where Virginia sits
The same service costs 4.8 times more in Wisconsin than in Washington, DC. 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· 34th of 51
$263
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.