How much rates vary
Facilitymedian $3,162 · 10th to 90th $1,000 to $11,482Professionalmedian $537 · 10th to 90th $91 to $813
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 $1,000.00 Median $7,585.78 Typical High $13,182.57 | Facility | None | $1,000.00 | $7,585.78 | $13,182.57 |
Aetna Setting Professional Modifier None Typical Low $562.34 Median $562.34 Typical High $1,698.24 | Professional | None | $562.34 | $562.34 | $1,698.24 |
Ambetter Setting Professional Modifier None Typical Low $302.00 Median $537.03 Typical High $660.69 | Professional | None | $302.00 | $537.03 | $660.69 |
Anthem BCBS Setting Facility Modifier None Typical Low $954.99 Median $2,691.53 Typical High $9,120.11 | Facility | None | $954.99 | $2,691.53 | $9,120.11 |
Anthem BCBS Setting Professional Modifier None Typical Low $426.58 Median $501.19 Typical High $758.58 | Professional | None | $426.58 | $501.19 | $758.58 |
CareSource Setting Facility Modifier None Typical Low $707.95 Median $2,754.23 Typical High $3,630.78 | Facility | None | $707.95 | $2,754.23 | $3,630.78 |
CareSource Setting Professional Modifier None Typical Low $602.56 Median $602.56 Typical High $676.08 | Professional | None | $602.56 | $602.56 | $676.08 |
Cigna Setting Facility Modifier None Typical Low $1,071.52 Median $3,162.28 Typical High $5,248.07 | Facility | None | $1,071.52 | $3,162.28 | $5,248.07 |
Cigna Setting Professional Modifier None Typical Low $549.54 Median $588.84 Typical High $933.25 | Professional | None | $549.54 | $588.84 | $933.25 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $1,071.52 Median $3,235.94 Typical High $5,248.07 | Facility | None | $1,071.52 | $3,235.94 | $5,248.07 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $549.54 Median $588.84 Typical High $977.24 | Professional | None | $549.54 | $588.84 | $977.24 |
Molina Setting Professional Modifier None Typical Low $64.57 Median $478.63 Typical High $758.58 | Professional | None | $64.57 | $478.63 | $758.58 |
SummaCare Setting Facility Modifier None Typical Low $1,548.82 Median $1,621.81 Typical High $1,862.09 | Facility | None | $1,548.82 | $1,621.81 | $1,862.09 |
SummaCare Setting Professional Modifier None Typical Low $562.34 Median $562.34 Typical High $691.83 | Professional | None | $562.34 | $562.34 | $691.83 |
United Setting Facility Modifier None Typical Low $912.01 Median $3,388.44 Typical High $11,748.98 | Facility | None | $912.01 | $3,388.44 | $11,748.98 |
United Setting Professional Modifier None Typical Low $467.74 Median $588.84 Typical High $912.01 | Professional | None | $467.74 | $588.84 | $912.01 |
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 Professional Modifier 52 · Reduced service Typical Low $281.84 Median $281.84 Typical High $363.08 | Professional | 52 · Reduced service | $281.84 | $281.84 | $363.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $112.20 Median $112.20 Typical High $147.91 | Professional | 53 · Discontinued | $112.20 | $112.20 | $147.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $426.58 Median $426.58 Typical High $549.54 | Professional | 54 · Surgery only | $426.58 | $426.58 | $549.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $85.11 Median $85.11 Typical High $109.65 | Professional | 55 · Aftercare only | $85.11 | $85.11 | $109.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $56.23 Median $56.23 Typical High $74.13 | Professional | 56 · Pre-op care only | $56.23 | $56.23 | $74.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $398.11 Median $398.11 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $398.11 | $398.11 | $512.86 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $645.65 Median $758.58 Typical High $1,148.15 | Professional | 50 · Both sides | $645.65 | $758.58 | $1,148.15 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $269.15 Median $316.23 Typical High $478.63 | Professional | 62 · Two surgeons | $269.15 | $316.23 | $478.63 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $67.61 Median $79.43 Typical High $123.03 | Professional | 80 · Assistant surgeon | $67.61 | $79.43 | $123.03 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $60.26 Median $70.79 Typical High $107.15 | Professional | AS · PA/NP assist | $60.26 | $70.79 | $107.15 |
Where Ohio sits
The same service costs 6.0 times more in Wisconsin 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
WI $11,096MT $1,846
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.