How much rates vary
Facilitymedian $1,175 · 10th to 90th $269 to $2,884Professionalmedian $224 · 10th to 90th $162 to $437
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 $154.88 Median $309.03 Typical High $794.33 | Facility | None | $154.88 | $309.03 | $794.33 |
Aetna Setting Professional Modifier None Typical Low $154.88 Median $269.15 Typical High $331.13 | Professional | None | $154.88 | $269.15 | $331.13 |
Ambetter Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $213.80 | Professional | None | $165.96 | $165.96 | $213.80 |
Anthem BCBS Setting Facility Modifier None Typical Low $602.56 Median $1,698.24 Typical High $2,884.03 | Facility | None | $602.56 | $1,698.24 | $2,884.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $151.36 Median $199.53 Typical High $331.13 | Professional | None | $151.36 | $199.53 | $331.13 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $229.09 Median $295.12 Typical High $501.19 | Professional | 50 · Both sides | $229.09 | $295.12 | $501.19 |
CareSource Setting Facility Modifier None Typical Low $169.82 Median $269.15 Typical High $1,412.54 | Facility | None | $169.82 | $269.15 | $1,412.54 |
CareSource Setting Professional Modifier None Typical Low $169.82 Median $229.09 Typical High $281.84 | Professional | None | $169.82 | $229.09 | $281.84 |
Cigna Setting Facility Modifier None Typical Low $302.00 Median $1,000.00 Typical High $1,318.26 | Facility | None | $302.00 | $1,000.00 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $302.00 Typical High $2,951.21 | Professional | None | $173.78 | $302.00 | $2,951.21 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $91.20 | Professional | None | $33.11 | $33.11 | $91.20 |
United Setting Facility Modifier None Typical Low $707.95 Median $1,174.90 Typical High $3,890.45 | Facility | None | $707.95 | $1,174.90 | $3,890.45 |
United Setting Professional Modifier None Typical Low $199.53 Median $323.59 Typical High $537.03 | Professional | None | $199.53 | $323.59 | $537.03 |
12 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 Facility Modifier 52 · Reduced service Typical Low $77.62 Median $131.83 Typical High $275.42 | Facility | 52 · Reduced service | $77.62 | $131.83 | $275.42 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $31.62 Median $53.70 Typical High $109.65 | Facility | 53 · Discontinued | $31.62 | $53.70 | $109.65 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $117.49 Median $199.53 Typical High $407.38 | Facility | 54 · Surgery only | $117.49 | $199.53 | $407.38 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $23.44 Median $39.81 Typical High $81.28 | Facility | 55 · Aftercare only | $23.44 | $39.81 | $81.28 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $15.49 Median $26.92 Typical High $54.95 | Facility | 56 · Pre-op care only | $15.49 | $26.92 | $54.95 |
Aetna Setting Facility Modifier 78 · Unplanned return to OR Typical Low $109.65 Median $186.21 Typical High $380.19 | Facility | 78 · Unplanned return to OR | $109.65 | $186.21 | $380.19 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $77.62 Median $131.83 Typical High $165.96 | Professional | 52 · Reduced service | $77.62 | $131.83 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $31.62 Median $52.48 Typical High $66.07 | Professional | 53 · Discontinued | $31.62 | $52.48 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $117.49 Median $194.98 Typical High $245.47 | Professional | 54 · Surgery only | $117.49 | $194.98 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.44 Median $38.90 Typical High $48.98 | Professional | 55 · Aftercare only | $23.44 | $38.90 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.49 Median $26.30 Typical High $33.11 | Professional | 56 · Pre-op care only | $15.49 | $26.30 | $33.11 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $109.65 Median $181.97 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $109.65 | $181.97 | $229.09 |
Where Kentucky sits
The same service costs 6.4 times more in Oklahoma than in North Dakota. 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
OK $5,125ND $804
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.