How much rates vary
Facilitymedian $141 · 10th to 90th $58 to $3,311Professionalmedian $123 · 10th to 90th $58 to $562
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 $60.26 Median $141.25 Typical High $851.14 | Facility | None | $60.26 | $141.25 | $851.14 |
Aetna Setting Professional Modifier None Typical Low $60.26 Median $141.25 Typical High $177.83 | Professional | None | $60.26 | $141.25 | $177.83 |
Anthem BCBS Setting Facility Modifier None Typical Low $9,120.11 Median $10,715.19 Typical High $11,220.18 | Facility | None | $9,120.11 | $10,715.19 | $11,220.18 |
Anthem BCBS Setting Professional Modifier None Typical Low $56.23 Median $117.49 Typical High $562.34 | Professional | None | $56.23 | $117.49 | $562.34 |
CareSource Setting Facility Modifier None Typical Low $48.98 Median $57.54 Typical High $91.20 | Facility | None | $48.98 | $57.54 | $91.20 |
CareSource Setting Professional Modifier None Typical Low $57.54 Median $77.62 Typical High $91.20 | Professional | None | $57.54 | $77.62 | $91.20 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $93.33 Typical High $93.33 | Facility | None | $34.67 | $93.33 | $93.33 |
Cigna Setting Professional Modifier None Typical Low $57.54 Median $138.04 Typical High $3,090.30 | Professional | None | $57.54 | $138.04 | $3,090.30 |
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 $50.12 Median $416.87 Typical High $1,949.84 | Facility | None | $50.12 | $416.87 | $1,949.84 |
United Setting Professional Modifier None Typical Low $69.18 Median $138.04 Typical High $239.88 | Professional | None | $69.18 | $138.04 | $239.88 |
10 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 $30.20 Median $69.18 Typical High $281.84 | Facility | 52 · Reduced service | $30.20 | $69.18 | $281.84 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $12.02 Median $28.18 Typical High $112.20 | Facility | 53 · Discontinued | $12.02 | $28.18 | $112.20 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $44.67 Median $104.71 Typical High $426.58 | Facility | 54 · Surgery only | $44.67 | $104.71 | $426.58 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $8.91 Median $20.89 Typical High $85.11 | Facility | 55 · Aftercare only | $8.91 | $20.89 | $85.11 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $6.03 Median $14.13 Typical High $56.23 | Facility | 56 · Pre-op care only | $6.03 | $14.13 | $56.23 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $30.20 Median $69.18 Typical High $89.13 | Professional | 52 · Reduced service | $30.20 | $69.18 | $89.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $28.18 Typical High $35.48 | Professional | 53 · Discontinued | $12.02 | $28.18 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $44.67 Median $104.71 Typical High $131.83 | Professional | 54 · Surgery only | $44.67 | $104.71 | $131.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.91 Median $20.89 Typical High $26.30 | Professional | 55 · Aftercare only | $8.91 | $20.89 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.03 Median $14.13 Typical High $17.78 | Professional | 56 · Pre-op care only | $6.03 | $14.13 | $17.78 |
Where Kentucky sits
The same service costs 3.7 times more in Wisconsin than in Maryland. 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· 44th of 51
$123
WI $302MD $81.28
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.