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 $4,365.16 Typical High $14,125.38 | Facility | None | $100.00 | $4,365.16 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $173.78 Typical High $707.95 | Professional | None | $85.11 | $173.78 | $707.95 |
Anthem BCBS Setting Professional Modifier None Typical Low $87.10 Median $208.93 Typical High $831.76 | Professional | None | $87.10 | $208.93 | $831.76 |
CareFirst Setting Professional Modifier None Typical Low $87.10 Median $97.72 Typical High $112.20 | Professional | None | $87.10 | $97.72 | $112.20 |
Cigna Setting Facility Modifier None Typical Low $218.78 Median $218.78 Typical High $251.19 | Facility | None | $218.78 | $218.78 | $251.19 |
Cigna Setting Professional Modifier None Typical Low $89.13 Median $213.80 Typical High $912.01 | Professional | None | $89.13 | $213.80 | $912.01 |
Kaiser Permanente Setting Professional Modifier None Typical Low $74.13 Median $831.76 Typical High $1,047.13 | Professional | None | $74.13 | $831.76 | $1,047.13 |
Medcost Setting Professional Modifier None Typical Low $208.93 Median $263.03 Typical High $288.40 | Professional | None | $208.93 | $263.03 | $288.40 |
Medcost Setting Facility Modifier None Typical Low $123.03 Median $169.82 Typical High $707.95 | Facility | None | $123.03 | $169.82 | $707.95 |
Medcost Setting Professional Modifier None Typical Low $100.00 Median $186.21 Typical High $524.81 | Professional | None | $100.00 | $186.21 | $524.81 |
Sentara Setting Facility Modifier None Typical Low $67.61 Median $123.03 Typical High $10,232.93 | Facility | None | $67.61 | $123.03 | $10,232.93 |
Sentara Setting Professional Modifier None Typical Low $158.49 Median $363.08 Typical High $1,348.96 | Professional | None | $158.49 | $363.08 | $1,348.96 |
United Setting Facility Modifier None Typical Low $1,778.28 Median $3,981.07 Typical High $7,244.36 | Facility | None | $1,778.28 | $3,981.07 | $7,244.36 |
United Setting Professional Modifier None Typical Low $79.43 Median $165.96 Typical High $776.25 | Professional | None | $79.43 | $165.96 | $776.25 |
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 $58.88 Typical High $354.81 | Professional | 52 · Reduced service | $42.66 | $58.88 | $354.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $23.44 Typical High $141.25 | Professional | 53 · Discontinued | $16.98 | $23.44 | $141.25 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $64.57 Median $87.10 Typical High $537.03 | Professional | 54 · Surgery only | $64.57 | $87.10 | $537.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $17.78 Typical High $107.15 | Professional | 55 · Aftercare only | $12.88 | $17.78 | $107.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $11.75 Typical High $70.79 | Professional | 56 · Pre-op care only | $8.51 | $11.75 | $70.79 |
Where Virginia sits
The same service costs 9.5 times more in Washington 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· 37th of 51
$195
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.