How much rates vary
Facilitymedian $3,090 · 10th to 90th $813 to $10,233Professionalmedian $692 · 10th to 90th $525 to $1,202
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 $1,258.93 Median $5,128.61 Typical High $12,589.25 | Facility | None | $1,258.93 | $5,128.61 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $724.44 Median $1,348.96 Typical High $8,912.51 | Professional | None | $724.44 | $1,348.96 | $8,912.51 |
Ambetter Setting Professional Modifier None Typical Low $588.84 Median $588.84 Typical High $588.84 | Professional | None | $588.84 | $588.84 | $588.84 |
Anthem BCBS Setting Facility Modifier None Typical Low $758.58 Median $2,290.87 Typical High $7,762.47 | Facility | None | $758.58 | $2,290.87 | $7,762.47 |
Anthem BCBS Setting Professional Modifier None Typical Low $562.34 Median $660.69 Typical High $1,096.48 | Professional | None | $562.34 | $660.69 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $354.81 Median $416.87 Typical High $691.83 | Professional | 62 · Two surgeons | $354.81 | $416.87 | $691.83 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $89.13 Median $107.15 Typical High $181.97 | Professional | 80 · Assistant surgeon | $89.13 | $107.15 | $181.97 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $77.62 Median $93.33 Typical High $154.88 | Professional | AS · PA/NP assist | $77.62 | $93.33 | $154.88 |
CareSource Setting Facility Modifier None Typical Low $812.83 Median $2,884.03 Typical High $3,801.89 | Facility | None | $812.83 | $2,884.03 | $3,801.89 |
Cigna Setting Facility Modifier None Typical Low $741.31 Median $3,388.44 Typical High $5,754.40 | Facility | None | $741.31 | $3,388.44 | $5,754.40 |
Cigna Setting Professional Modifier None Typical Low $660.69 Median $794.33 Typical High $1,380.38 | Professional | None | $660.69 | $794.33 | $1,380.38 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $741.31 Median $3,388.44 Typical High $5,754.40 | Facility | None | $741.31 | $3,388.44 | $5,754.40 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $676.08 Median $812.83 Typical High $1,479.11 | Professional | None | $676.08 | $812.83 | $1,479.11 |
Molina Setting Professional Modifier None Typical Low $446.68 Median $645.65 Typical High $831.76 | Professional | None | $446.68 | $645.65 | $831.76 |
SummaCare Setting Facility Modifier None Typical Low $1,659.59 Median $1,737.80 Typical High $1,949.84 | Facility | None | $1,659.59 | $1,737.80 | $1,949.84 |
SummaCare Setting Professional Modifier None Typical Low $630.96 Median $691.83 Typical High $1,202.26 | Professional | None | $630.96 | $691.83 | $1,202.26 |
United Setting Facility Modifier None Typical Low $912.01 Median $3,388.44 Typical High $11,748.98 | Facility | None | $912.01 | $3,388.44 | $11,748.98 |
United Setting Professional Modifier None Typical Low $691.83 Median $891.25 Typical High $1,949.84 | Professional | None | $691.83 | $891.25 | $1,949.84 |
6 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 $363.08 Median $363.08 Typical High $1,071.52 | Professional | 52 · Reduced service | $363.08 | $363.08 | $1,071.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $147.91 Typical High $426.58 | Professional | 53 · Discontinued | $147.91 | $147.91 | $426.58 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $549.54 Typical High $1,621.81 | Professional | 54 · Surgery only | $549.54 | $549.54 | $1,621.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $109.65 Typical High $323.59 | Professional | 55 · Aftercare only | $109.65 | $109.65 | $323.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $72.44 Typical High $213.80 | Professional | 56 · Pre-op care only | $72.44 | $72.44 | $213.80 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $512.86 Typical High $1,513.56 | Professional | 78 · Unplanned return to OR | $512.86 | $512.86 | $1,513.56 |
Where Ohio sits
The same service costs 5.3 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 $10,556MT $2,002
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.