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 $14.45 Median $14.45 Typical High $15.85 | Facility | None | $14.45 | $14.45 | $15.85 |
Aetna Setting Professional Modifier None Typical Low $14.45 Median $14.45 Typical High $15.85 | Professional | None | $14.45 | $14.45 | $15.85 |
Anthem BCBS Setting Professional Modifier None Typical Low $22.91 Median $22.91 Typical High $22.91 | Professional | None | $22.91 | $22.91 | $22.91 |
CareFirst Setting Professional Modifier None Typical Low $13.49 Median $13.49 Typical High $13.49 | Professional | None | $13.49 | $13.49 | $13.49 |
Cigna Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $9.77 | Professional | None | $9.77 | $9.77 | $9.77 |
Kaiser Permanente Setting Professional Modifier None Typical Low $20.42 Median $26.30 Typical High $38.90 | Professional | None | $20.42 | $26.30 | $38.90 |
Medcost Setting Facility Modifier None Typical Low $14.45 Median $34.67 Typical High $46.77 | Facility | None | $14.45 | $34.67 | $46.77 |
Medcost Setting Professional Modifier None Typical Low $12.88 Median $12.88 Typical High $23.99 | Professional | None | $12.88 | $12.88 | $23.99 |
Sentara Setting Facility Modifier None Typical Low $18.20 Median $41.69 Typical High $10,232.93 | Facility | None | $18.20 | $41.69 | $10,232.93 |
Sentara Setting Professional Modifier None Typical Low $13.80 Median $37.15 Typical High $64.57 | Professional | None | $13.80 | $37.15 | $64.57 |
United Setting Professional Modifier None Typical Low $10.23 Median $11.75 Typical High $16.98 | Professional | None | $10.23 | $11.75 | $16.98 |
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 $7.24 Median $7.24 Typical High $7.94 | Professional | 52 · Reduced service | $7.24 | $7.24 | $7.94 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.95 Median $2.95 Typical High $3.16 | Professional | 53 · Discontinued | $2.95 | $2.95 | $3.16 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.96 Median $10.96 Typical High $12.02 | Professional | 54 · Surgery only | $10.96 | $10.96 | $12.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.19 Median $2.19 Typical High $2.40 | Professional | 55 · Aftercare only | $2.19 | $2.19 | $2.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.45 Median $1.45 Typical High $1.58 | Professional | 56 · Pre-op care only | $1.45 | $1.45 | $1.58 |
Where Virginia sits
The same service costs 3.2 times more in Rhode Island 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· 24th of 51
$15.85
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.