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 $79.43 Median $4,073.80 Typical High $10,000.00 | Facility | None | $79.43 | $4,073.80 | $10,000.00 |
Aetna Setting Professional Modifier None Typical Low $67.61 Median $158.49 Typical High $194.98 | Professional | None | $67.61 | $158.49 | $194.98 |
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 $67.61 Median $134.90 Typical High $208.93 | Professional | None | $67.61 | $134.90 | $208.93 |
CareFirst Setting Professional Modifier None Typical Low $53.70 Median $60.26 Typical High $60.26 | Professional | None | $53.70 | $60.26 | $60.26 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $199.53 Typical High $239.88 | Facility | None | $151.36 | $199.53 | $239.88 |
Cigna Setting Professional Modifier None Typical Low $54.95 Median $134.90 Typical High $239.88 | Professional | None | $54.95 | $134.90 | $239.88 |
Kaiser Permanente Setting Professional Modifier None Typical Low $138.04 Median $177.83 Typical High $213.80 | Professional | None | $138.04 | $177.83 | $213.80 |
Medcost Setting Professional Modifier None Typical Low $190.55 Median $467.74 Typical High $467.74 | Professional | None | $190.55 | $467.74 | $467.74 |
Medcost Setting Facility Modifier None Typical Low $79.43 Median $138.04 Typical High $323.59 | Facility | None | $79.43 | $138.04 | $323.59 |
Medcost Setting Professional Modifier None Typical Low $831.76 Median $831.76 Typical High $831.76 | Professional | None | $831.76 | $831.76 | $831.76 |
Sentara Setting Facility Modifier None Typical Low $57.54 Median $117.49 Typical High $10,232.93 | Facility | None | $57.54 | $117.49 | $10,232.93 |
Sentara Setting Professional Modifier None Typical Low $123.03 Median $204.17 Typical High $426.58 | Professional | None | $123.03 | $204.17 | $426.58 |
United Setting Facility Modifier None Typical Low $380.19 Median $416.87 Typical High $933.25 | Facility | None | $380.19 | $416.87 | $933.25 |
United Setting Professional Modifier None Typical Low $60.26 Median $128.82 Typical High $245.47 | Professional | None | $60.26 | $128.82 | $245.47 |
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 $33.88 Median $44.67 Typical High $95.50 | Professional | 52 · Reduced service | $33.88 | $44.67 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.49 Median $17.78 Typical High $38.02 | Professional | 53 · Discontinued | $13.49 | $17.78 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $50.12 Median $67.61 Typical High $141.25 | Professional | 54 · Surgery only | $50.12 | $67.61 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $13.49 Typical High $28.84 | Professional | 55 · Aftercare only | $10.00 | $13.49 | $28.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.76 Median $8.91 Typical High $19.05 | Professional | 56 · Pre-op care only | $6.76 | $8.91 | $19.05 |
Where Virginia sits
The same service costs 3.5 times more in Alaska than in Maryland. 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
$138
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.