How much rates vary
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 $7,585.78 Median $7,585.78 Typical High $14,454.40 | Facility | None | $7,585.78 | $7,585.78 | $14,454.40 |
Aetna Setting Professional Modifier None Typical Low $7,585.78 Median $7,585.78 Typical High $17,378.01 | Professional | None | $7,585.78 | $7,585.78 | $17,378.01 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $3,801.89 Median $3,801.89 Typical High $8,709.64 | Professional | 52 · Reduced service | $3,801.89 | $3,801.89 | $8,709.64 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1,513.56 Median $1,513.56 Typical High $3,467.37 | Professional | 53 · Discontinued | $1,513.56 | $1,513.56 | $3,467.37 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $5,623.41 Median $5,623.41 Typical High $12,882.50 | Professional | 54 · Surgery only | $5,623.41 | $5,623.41 | $12,882.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1,122.02 Median $1,122.02 Typical High $2,570.40 | Professional | 55 · Aftercare only | $1,122.02 | $1,122.02 | $2,570.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $758.58 Median $758.58 Typical High $1,737.80 | Professional | 56 · Pre-op care only | $758.58 | $758.58 | $1,737.80 |
Anthem BCBS Setting Facility Modifier None Typical Low $5,011.87 Median $8,317.64 Typical High $11,748.98 | Facility | None | $5,011.87 | $8,317.64 | $11,748.98 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,122.02 Median $3,890.45 Typical High $4,570.88 | Professional | None | $1,122.02 | $3,890.45 | $4,570.88 |
DeanCare Setting Facility Modifier None Typical Low $6,165.95 Median $8,128.31 Typical High $14,791.08 | Facility | None | $6,165.95 | $8,128.31 | $14,791.08 |
Medica Setting Facility Modifier None Typical Low $426.58 Median $2,691.53 Typical High $18,197.01 | Facility | None | $426.58 | $2,691.53 | $18,197.01 |
Medica Setting Professional Modifier None Typical Low $42,657.95 Median $42,657.95 Typical High $42,657.95 | Professional | None | $42,657.95 | $42,657.95 | $42,657.95 |
Network Health Setting Facility Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Facility | None | $2,089.30 | $2,089.30 | $2,089.30 |
Prevea360 Setting Facility Modifier None Typical Low $3,162.28 Median $3,162.28 Typical High $3,162.28 | Facility | None | $3,162.28 | $3,162.28 | $3,162.28 |
United Setting Facility Modifier None Typical Low $602.56 Median $3,090.30 Typical High $18,197.01 | Facility | None | $602.56 | $3,090.30 | $18,197.01 |
United Setting Professional Modifier None Typical Low $34.67 Median $34.67 Typical High $34.67 | Professional | None | $34.67 | $34.67 | $34.67 |
2 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 |
|---|---|---|---|---|---|
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $181.97 Median $616.60 Typical High $724.44 | Professional | 80 · Assistant surgeon | $181.97 | $616.60 | $724.44 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $158.49 Median $537.03 Typical High $630.96 | Professional | AS · PA/NP assist | $158.49 | $537.03 | $630.96 |
Where Wisconsin sits
The same service costs 257.0 times more in Wisconsin than in Hawaii. 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.
Wisconsin· 1st of 51
$7,586
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.