How much rates vary
Facilitymedian $1,479 · 10th to 90th $417 to $5,248Professionalmedian $158 · 10th to 90th $78 to $263
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 $281.84 Median $3,235.94 Typical High $12,589.25 | Facility | None | $281.84 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $208.93 Typical High $251.19 | Professional | None | $120.23 | $208.93 | $251.19 |
Anthem BCBS Setting Facility Modifier None Typical Low $467.74 Median $1,202.26 Typical High $4,466.84 | Facility | None | $467.74 | $1,202.26 | $4,466.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $97.72 Median $141.25 Typical High $234.42 | Professional | None | $97.72 | $141.25 | $234.42 |
CareSource Setting Facility Modifier None Typical Low $147.91 Median $1,348.96 Typical High $1,737.80 | Facility | None | $147.91 | $1,348.96 | $1,737.80 |
CareSource Setting Professional Modifier None Typical Low $125.89 Median $125.89 Typical High $144.54 | Professional | None | $125.89 | $125.89 | $144.54 |
Cigna Setting Facility Modifier None Typical Low $363.08 Median $1,479.11 Typical High $2,290.87 | Facility | None | $363.08 | $1,479.11 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $112.20 Median $190.55 Typical High $281.84 | Professional | None | $112.20 | $190.55 | $281.84 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $389.05 Median $1,479.11 Typical High $2,238.72 | Facility | None | $389.05 | $1,479.11 | $2,238.72 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $112.20 Median $190.55 Typical High $281.84 | Professional | None | $112.20 | $190.55 | $281.84 |
Molina Setting Professional Modifier None Typical Low $30.20 Median $158.49 Typical High $269.15 | Professional | None | $30.20 | $158.49 | $269.15 |
SummaCare Setting Facility Modifier None Typical Low $758.58 Median $794.33 Typical High $912.01 | Facility | None | $758.58 | $794.33 | $912.01 |
SummaCare Setting Professional Modifier None Typical Low $112.20 Median $169.82 Typical High $245.47 | Professional | None | $112.20 | $169.82 | $245.47 |
United Setting Facility Modifier None Typical Low $501.19 Median $977.24 Typical High $4,786.30 | Facility | None | $501.19 | $977.24 | $4,786.30 |
United Setting Professional Modifier None Typical Low $102.33 Median $165.96 Typical High $263.03 | Professional | None | $102.33 | $165.96 | $263.03 |
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 $60.26 Median $102.33 Typical High $102.33 | Professional | 52 · Reduced service | $60.26 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $40.74 Typical High $41.69 | Professional | 53 · Discontinued | $23.99 | $40.74 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $151.36 Typical High $154.88 | Professional | 54 · Surgery only | $91.20 | $151.36 | $154.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $30.20 Typical High $30.90 | Professional | 55 · Aftercare only | $18.20 | $30.20 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $20.42 Typical High $20.89 | Professional | 56 · Pre-op care only | $12.02 | $20.42 | $20.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $141.25 Typical High $144.54 | Professional | 78 · Unplanned return to OR | $85.11 | $141.25 | $144.54 |
Where Ohio sits
The same service costs 9.8 times more in Colorado 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
CO $4,589ND $469
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.