How much rates vary
Facilitymedian $1,230 · 10th to 90th $617 to $8,128Professionalmedian $309 · 10th to 90th $240 to $501
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 $537.03 Median $5,128.61 Typical High $12,589.25 | Facility | None | $537.03 | $5,128.61 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $288.40 Median $302.00 Typical High $8,511.38 | Professional | None | $288.40 | $302.00 | $8,511.38 |
Anthem BCBS Setting Facility Modifier None Typical Low $630.96 Median $1,230.27 Typical High $4,786.30 | Facility | None | $630.96 | $1,230.27 | $4,786.30 |
Anthem BCBS Setting Professional Modifier None Typical Low $223.87 Median $288.40 Typical High $489.78 | Professional | None | $223.87 | $288.40 | $489.78 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $141.25 Median $181.97 Typical High $302.00 | Professional | 62 · Two surgeons | $141.25 | $181.97 | $302.00 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $36.31 Median $44.67 Typical High $81.28 | Professional | 80 · Assistant surgeon | $36.31 | $44.67 | $81.28 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $31.62 Median $39.81 Typical High $69.18 | Professional | AS · PA/NP assist | $31.62 | $39.81 | $69.18 |
CareSource Setting Facility Modifier None Typical Low $363.08 Median $933.25 Typical High $1,202.26 | Facility | None | $363.08 | $933.25 | $1,202.26 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $1,071.52 Typical High $2,951.21 | Facility | None | $691.83 | $1,071.52 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $275.42 Median $331.13 Typical High $616.60 | Professional | None | $275.42 | $331.13 | $616.60 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $741.31 Median $1,071.52 Typical High $2,951.21 | Facility | None | $741.31 | $1,071.52 | $2,951.21 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $275.42 Median $323.59 Typical High $616.60 | Professional | None | $275.42 | $323.59 | $616.60 |
Molina Setting Professional Modifier None Typical Low $234.42 Median $316.23 Typical High $416.87 | Professional | None | $234.42 | $316.23 | $416.87 |
SummaCare Setting Facility Modifier None Typical Low $512.86 Median $537.03 Typical High $616.60 | Facility | None | $512.86 | $537.03 | $616.60 |
SummaCare Setting Professional Modifier None Typical Low $275.42 Median $275.42 Typical High $457.09 | Professional | None | $275.42 | $275.42 | $457.09 |
United Setting Facility Modifier None Typical Low $691.83 Median $1,445.44 Typical High $5,888.44 | Facility | None | $691.83 | $1,445.44 | $5,888.44 |
United Setting Professional Modifier None Typical Low $275.42 Median $338.84 Typical High $707.95 | Professional | None | $275.42 | $338.84 | $707.95 |
7 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 $144.54 Median $144.54 Typical High $630.96 | Professional | 52 · Reduced service | $144.54 | $144.54 | $630.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $57.54 Median $57.54 Typical High $251.19 | Professional | 53 · Discontinued | $57.54 | $57.54 | $251.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $218.78 Median $218.78 Typical High $933.25 | Professional | 54 · Surgery only | $218.78 | $218.78 | $933.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $43.65 Median $43.65 Typical High $190.55 | Professional | 55 · Aftercare only | $43.65 | $43.65 | $190.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.84 Median $28.84 Typical High $125.89 | Professional | 56 · Pre-op care only | $28.84 | $28.84 | $125.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $204.17 Median $204.17 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $204.17 | $204.17 | $870.96 |
Ambetter Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $316.23 Typical High $316.23 | Professional | 53 · Discontinued | $316.23 | $316.23 | $316.23 |
Where Ohio sits
The same service costs 6.6 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 $6,126MT $925
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.