How much rates vary
Facilitymedian $186 · 10th to 90th $87 to $1,380Professionalmedian $200 · 10th to 90th $117 to $316
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 $141.25 Median $186.21 Typical High $263.03 | Facility | None | $141.25 | $186.21 | $263.03 |
Aetna Setting Professional Modifier None Typical Low $141.25 Median $208.93 Typical High $263.03 | Professional | None | $141.25 | $208.93 | $263.03 |
Anthem BCBS Setting Facility Modifier None Typical Low $575.44 Median $3,801.89 Typical High $11,220.18 | Facility | None | $575.44 | $3,801.89 | $11,220.18 |
Anthem BCBS Setting Professional Modifier None Typical Low $114.82 Median $181.97 Typical High $239.88 | Professional | None | $114.82 | $181.97 | $239.88 |
CareSource Setting Facility Modifier None Typical Low $131.83 Median $162.18 Typical High $213.80 | Facility | None | $131.83 | $162.18 | $213.80 |
CareSource Setting Professional Modifier None Typical Low $131.83 Median $186.21 Typical High $218.78 | Professional | None | $131.83 | $186.21 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $147.91 Typical High $239.88 | Facility | None | $34.67 | $147.91 | $239.88 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $239.88 Typical High $1,122.02 | Professional | None | $134.90 | $239.88 | $1,122.02 |
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 $70.79 Median $186.21 Typical High $1,148.15 | Facility | None | $70.79 | $186.21 | $1,148.15 |
United Setting Professional Modifier None Typical Low $177.83 Median $269.15 Typical High $398.11 | Professional | None | $177.83 | $269.15 | $398.11 |
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 $70.79 Median $93.33 Typical High $131.83 | Facility | 52 · Reduced service | $70.79 | $93.33 | $131.83 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $28.18 Median $37.15 Typical High $52.48 | Facility | 53 · Discontinued | $28.18 | $37.15 | $52.48 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $104.71 Median $141.25 Typical High $199.53 | Facility | 54 · Surgery only | $104.71 | $141.25 | $199.53 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $20.89 Median $28.18 Typical High $39.81 | Facility | 55 · Aftercare only | $20.89 | $28.18 | $39.81 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $14.13 Median $18.62 Typical High $26.30 | Facility | 56 · Pre-op care only | $14.13 | $18.62 | $26.30 |
Aetna Setting Facility Modifier 78 · Unplanned return to OR Typical Low $97.72 Median $131.83 Typical High $186.21 | Facility | 78 · Unplanned return to OR | $97.72 | $131.83 | $186.21 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $70.79 Median $102.33 Typical High $131.83 | Professional | 52 · Reduced service | $70.79 | $102.33 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $40.74 Typical High $52.48 | Professional | 53 · Discontinued | $28.18 | $40.74 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $104.71 Median $151.36 Typical High $199.53 | Professional | 54 · Surgery only | $104.71 | $151.36 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.89 Median $30.20 Typical High $39.81 | Professional | 55 · Aftercare only | $20.89 | $30.20 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $20.42 Typical High $26.30 | Professional | 56 · Pre-op care only | $14.13 | $20.42 | $26.30 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $97.72 Median $141.25 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $97.72 | $141.25 | $186.21 |
Where Kentucky sits
The same service costs 3.7 times more in Wisconsin than in Texas. 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.
Kentucky· 49th of 51
$195
WI $708TX $191
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.