How much rates vary
Facilitymedian $2,630 · 10th to 90th $457 to $8,318Professionalmedian $191 · 10th to 90th $117 to $302
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 $128.82 Median $2,344.23 Typical High $5,623.41 | Facility | None | $128.82 | $2,344.23 | $5,623.41 |
Aetna Setting Professional Modifier None Typical Low $128.82 Median $181.97 Typical High $213.80 | Professional | None | $128.82 | $181.97 | $213.80 |
Ambetter Setting Professional Modifier None Typical Low $114.82 Median $114.82 Typical High $114.82 | Professional | None | $114.82 | $114.82 | $114.82 |
Anthem BCBS Setting Facility Modifier None Typical Low $616.60 Median $5,011.87 Typical High $9,549.93 | Facility | None | $616.60 | $5,011.87 | $9,549.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $107.15 Median $186.21 Typical High $309.03 | Professional | None | $107.15 | $186.21 | $309.03 |
CareSource Setting Facility Modifier None Typical Low $134.90 Median $134.90 Typical High $2,041.74 | Facility | None | $134.90 | $134.90 | $2,041.74 |
Cigna Setting Facility Modifier None Typical Low $162.18 Median $1,348.96 Typical High $2,398.83 | Facility | None | $162.18 | $1,348.96 | $2,398.83 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $199.53 Typical High $288.40 | Professional | None | $134.90 | $199.53 | $288.40 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $363.08 Median $2,089.30 Typical High $3,090.30 | Facility | None | $363.08 | $2,089.30 | $3,090.30 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $138.04 Median $223.87 Typical High $338.84 | Professional | None | $138.04 | $223.87 | $338.84 |
United Setting Facility Modifier None Typical Low $512.86 Median $1,949.84 Typical High $4,677.35 | Facility | None | $512.86 | $1,949.84 | $4,677.35 |
United Setting Professional Modifier None Typical Low $125.89 Median $194.98 Typical High $323.59 | Professional | None | $125.89 | $194.98 | $323.59 |
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 $64.57 Median $91.20 Typical High $107.15 | Professional | 52 · Reduced service | $64.57 | $91.20 | $107.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $36.31 Typical High $42.66 | Professional | 53 · Discontinued | $25.70 | $36.31 | $42.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $138.04 Typical High $162.18 | Professional | 54 · Surgery only | $95.50 | $138.04 | $162.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $27.54 Typical High $32.36 | Professional | 55 · Aftercare only | $19.50 | $27.54 | $32.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $18.20 Typical High $21.38 | Professional | 56 · Pre-op care only | $12.88 | $18.20 | $21.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $128.82 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $91.20 | $128.82 | $151.36 |
Where Indiana sits
The same service costs 9.9 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 $4,605MT $466
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.