How much rates vary
Facilitymedian $1,995 · 10th to 90th $661 to $9,120Professionalmedian $513 · 10th to 90th $89 to $851
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 $2,089.30 Median $7,244.36 Typical High $12,589.25 | Facility | None | $2,089.30 | $7,244.36 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $630.96 Median $630.96 Typical High $4,168.69 | Professional | None | $630.96 | $630.96 | $4,168.69 |
Anthem BCBS Setting Facility Modifier None Typical Low $630.96 Median $1,698.24 Typical High $7,585.78 | Facility | None | $630.96 | $1,698.24 | $7,585.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $501.19 Median $630.96 Typical High $1,000.00 | Professional | None | $501.19 | $630.96 | $1,000.00 |
CareSource Setting Facility Modifier None Typical Low $794.33 Median $1,513.56 Typical High $1,995.26 | Facility | None | $794.33 | $1,513.56 | $1,995.26 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $1,737.80 Typical High $2,691.53 | Facility | None | $602.56 | $1,737.80 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $630.96 Median $812.83 Typical High $1,174.90 | Professional | None | $630.96 | $812.83 | $1,174.90 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $602.56 Median $1,737.80 Typical High $2,691.53 | Facility | None | $602.56 | $1,737.80 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $645.65 Median $812.83 Typical High $1,174.90 | Professional | None | $645.65 | $812.83 | $1,174.90 |
Molina Setting Professional Modifier None Typical Low $70.79 Median $407.38 Typical High $707.95 | Professional | None | $70.79 | $407.38 | $707.95 |
SummaCare Setting Facility Modifier None Typical Low $851.14 Median $891.25 Typical High $1,000.00 | Facility | None | $851.14 | $891.25 | $1,000.00 |
SummaCare Setting Professional Modifier None Typical Low $549.54 Median $602.56 Typical High $794.33 | Professional | None | $549.54 | $602.56 | $794.33 |
United Setting Facility Modifier None Typical Low $707.95 Median $1,905.46 Typical High $7,244.36 | Facility | None | $707.95 | $1,905.46 | $7,244.36 |
United Setting Professional Modifier None Typical Low $398.11 Median $676.08 Typical High $1,148.15 | Professional | None | $398.11 | $676.08 | $1,148.15 |
9 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 $316.23 Median $316.23 Typical High $1,258.93 | Professional | 52 · Reduced service | $316.23 | $316.23 | $1,258.93 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $125.89 Median $125.89 Typical High $501.19 | Professional | 53 · Discontinued | $125.89 | $125.89 | $501.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $467.74 Median $467.74 Typical High $1,905.46 | Professional | 54 · Surgery only | $467.74 | $467.74 | $1,905.46 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $93.33 Median $93.33 Typical High $380.19 | Professional | 55 · Aftercare only | $93.33 | $93.33 | $380.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $63.10 Median $63.10 Typical High $251.19 | Professional | 56 · Pre-op care only | $63.10 | $63.10 | $251.19 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $436.52 Median $436.52 Typical High $1,778.28 | Professional | 78 · Unplanned return to OR | $436.52 | $436.52 | $1,778.28 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $758.58 Median $954.99 Typical High $1,479.11 | Professional | 50 · Both sides | $758.58 | $954.99 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $81.28 Median $102.33 Typical High $158.49 | Professional | 80 · Assistant surgeon | $81.28 | $102.33 | $158.49 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $70.79 Median $89.13 Typical High $141.25 | Professional | AS · PA/NP assist | $70.79 | $89.13 | $141.25 |
Where Ohio sits
The same service costs 3.7 times more in Wisconsin than in Montana. 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.
Physician feeFacility fee
WI $7,647MT $2,070
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.