How much rates vary
Facilitymedian $1,072 · 10th to 90th $324 to $4,677Professionalmedian $132 · 10th to 90th $81 to $240
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 $181.97 Median $478.63 Typical High $10,715.19 | Facility | None | $181.97 | $478.63 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $100.00 Median $144.54 Typical High $1,995.26 | Professional | None | $100.00 | $144.54 | $1,995.26 |
Anthem BCBS Setting Facility Modifier None Typical Low $467.74 Median $1,148.15 Typical High $4,466.84 | Facility | None | $467.74 | $1,148.15 | $4,466.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $77.62 Median $125.89 Typical High $257.04 | Professional | None | $77.62 | $125.89 | $257.04 |
CareSource Setting Facility Modifier None Typical Low $117.49 Median $954.99 Typical High $1,230.27 | Facility | None | $117.49 | $954.99 | $1,230.27 |
Cigna Setting Facility Modifier None Typical Low $363.08 Median $1,202.26 Typical High $1,819.70 | Facility | None | $363.08 | $1,202.26 | $1,819.70 |
Cigna Setting Professional Modifier None Typical Low $89.13 Median $144.54 Typical High $269.15 | Professional | None | $89.13 | $144.54 | $269.15 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $389.05 Median $1,202.26 Typical High $1,698.24 | Facility | None | $389.05 | $1,202.26 | $1,698.24 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $89.13 Median $144.54 Typical High $275.42 | Professional | None | $89.13 | $144.54 | $275.42 |
Molina Setting Professional Modifier None Typical Low $100.00 Median $141.25 Typical High $204.17 | Professional | None | $100.00 | $141.25 | $204.17 |
SummaCare Setting Facility Modifier None Typical Low $575.44 Median $616.60 Typical High $691.83 | Facility | None | $575.44 | $616.60 | $691.83 |
SummaCare Setting Professional Modifier None Typical Low $91.20 Median $141.25 Typical High $186.21 | Professional | None | $91.20 | $141.25 | $186.21 |
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 $85.11 Median $134.90 Typical High $245.47 | Professional | None | $85.11 | $134.90 | $245.47 |
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 $50.12 Median $72.44 Typical High $72.44 | Professional | 52 · Reduced service | $50.12 | $72.44 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $28.84 Typical High $28.84 | Professional | 53 · Discontinued | $19.95 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $107.15 Typical High $107.15 | Professional | 54 · Surgery only | $74.13 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $21.38 Typical High $21.38 | Professional | 55 · Aftercare only | $15.14 | $21.38 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $14.45 Typical High $14.45 | Professional | 56 · Pre-op care only | $10.00 | $14.45 | $14.45 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $100.00 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $69.18 | $100.00 | $100.00 |
Where Ohio sits
The same service costs 13.0 times more in Colorado 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
CO $4,547MT $350
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.