How much rates vary
Facilitymedian $1,175 · 10th to 90th $191 to $4,786Professionalmedian $219 · 10th to 90th $115 to $380
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 $128.82 Median $239.88 Typical High $562.34 | Facility | None | $128.82 | $239.88 | $562.34 |
Aetna Setting Professional Modifier None Typical Low $128.82 Median $239.88 Typical High $398.11 | Professional | None | $128.82 | $239.88 | $398.11 |
Ambetter Setting Professional Modifier None Typical Low $70.79 Median $158.49 Typical High $162.18 | Professional | None | $70.79 | $158.49 | $162.18 |
Anthem BCBS Setting Facility Modifier None Typical Low $724.44 Median $2,454.71 Typical High $5,370.32 | Facility | None | $724.44 | $2,454.71 | $5,370.32 |
Anthem BCBS Setting Professional Modifier None Typical Low $114.82 Median $213.80 Typical High $316.23 | Professional | None | $114.82 | $213.80 | $316.23 |
CareSource Setting Facility Modifier None Typical Low $120.23 Median $169.82 Typical High $1,348.96 | Facility | None | $120.23 | $169.82 | $1,348.96 |
CareSource Setting Professional Modifier None Typical Low $154.88 Median $229.09 Typical High $323.59 | Professional | None | $154.88 | $229.09 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $213.80 Median $977.24 Typical High $1,659.59 | Facility | None | $213.80 | $977.24 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $125.89 Median $234.42 Typical High $1,380.38 | Professional | None | $125.89 | $234.42 | $1,380.38 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
United Setting Facility Modifier None Typical Low $457.09 Median $794.33 Typical High $2,454.71 | Facility | None | $457.09 | $794.33 | $2,454.71 |
United Setting Professional Modifier None Typical Low $147.91 Median $251.19 Typical High $446.68 | Professional | None | $147.91 | $251.19 | $446.68 |
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 $64.57 Median $120.23 Typical High $123.03 | Facility | 52 · Reduced service | $64.57 | $120.23 | $123.03 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $25.70 Median $47.86 Typical High $50.12 | Facility | 53 · Discontinued | $25.70 | $47.86 | $50.12 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $95.50 Median $177.83 Typical High $186.21 | Facility | 54 · Surgery only | $95.50 | $177.83 | $186.21 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $19.50 Median $35.48 Typical High $37.15 | Facility | 55 · Aftercare only | $19.50 | $35.48 | $37.15 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $12.88 Median $23.99 Typical High $25.12 | Facility | 56 · Pre-op care only | $12.88 | $23.99 | $25.12 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $64.57 Median $117.49 Typical High $123.03 | Professional | 52 · Reduced service | $64.57 | $117.49 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $47.86 Typical High $50.12 | Professional | 53 · Discontinued | $25.70 | $47.86 | $50.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $177.83 Typical High $186.21 | Professional | 54 · Surgery only | $95.50 | $177.83 | $186.21 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $35.48 Typical High $37.15 | Professional | 55 · Aftercare only | $19.50 | $35.48 | $37.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $23.44 Typical High $25.12 | Professional | 56 · Pre-op care only | $12.88 | $23.44 | $25.12 |
Ambetter Setting Professional Modifier 51 · Multiple procedures Typical Low $74.13 Median $74.13 Typical High $83.18 | Professional | 51 · Multiple procedures | $74.13 | $74.13 | $83.18 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $147.91 Median $147.91 Typical High $147.91 | Professional | GC · Resident with teaching physician | $147.91 | $147.91 | $147.91 |
Where Kentucky sits
The same service costs 8.2 times more in Colorado than in West Virginia. 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
CO $4,192WV $514
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.