How much rates vary
Facilitymedian $1,072 · 10th to 90th $501 to $5,248Professionalmedian $288 · 10th to 90th $245 to $457
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 $501.19 Median $3,715.35 Typical High $12,022.64 | Facility | None | $501.19 | $3,715.35 | $12,022.64 |
Aetna Setting Professional Modifier None Typical Low $275.42 Median $275.42 Typical High $1,071.52 | Professional | None | $275.42 | $275.42 | $1,071.52 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $1,174.90 Typical High $4,466.84 | Facility | None | $524.81 | $1,174.90 | $4,466.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $245.47 Median $288.40 Typical High $436.52 | Professional | None | $245.47 | $288.40 | $436.52 |
CareSource Setting Facility Modifier None Typical Low $346.74 Median $831.76 Typical High $1,096.48 | Facility | None | $346.74 | $831.76 | $1,096.48 |
CareSource Setting Professional Modifier None Typical Low $295.12 Median $295.12 Typical High $331.13 | Professional | None | $295.12 | $295.12 | $331.13 |
Cigna Setting Facility Modifier None Typical Low $512.86 Median $954.99 Typical High $1,995.26 | Facility | None | $512.86 | $954.99 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $269.15 Median $302.00 Typical High $524.81 | Professional | None | $269.15 | $302.00 | $524.81 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $512.86 Median $954.99 Typical High $1,995.26 | Facility | None | $512.86 | $954.99 | $1,995.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $269.15 Median $302.00 Typical High $524.81 | Professional | None | $269.15 | $302.00 | $524.81 |
Molina Setting Professional Modifier None Typical Low $223.87 Median $281.84 Typical High $426.58 | Professional | None | $223.87 | $281.84 | $426.58 |
SummaCare Setting Facility Modifier None Typical Low $457.09 Median $478.63 Typical High $549.54 | Facility | None | $457.09 | $478.63 | $549.54 |
SummaCare Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $302.00 | Professional | None | $257.04 | $257.04 | $302.00 |
United Setting Facility Modifier None Typical Low $501.19 Median $977.24 Typical High $4,677.35 | Facility | None | $501.19 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $234.42 Median $302.00 Typical High $467.74 | Professional | None | $234.42 | $302.00 | $467.74 |
5 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 $138.04 Median $138.04 Typical High $181.97 | Professional | 52 · Reduced service | $138.04 | $138.04 | $181.97 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $54.95 Median $54.95 Typical High $74.13 | Professional | 53 · Discontinued | $54.95 | $54.95 | $74.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $208.93 Typical High $275.42 | Professional | 54 · Surgery only | $208.93 | $208.93 | $275.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $41.69 Typical High $54.95 | Professional | 55 · Aftercare only | $41.69 | $41.69 | $54.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $27.54 Median $27.54 Typical High $37.15 | Professional | 56 · Pre-op care only | $27.54 | $27.54 | $37.15 |
Where Ohio sits
The same service costs 5.2 times more in Oklahoma 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
OK $4,508MT $873
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.