How much rates vary
Facilitymedian $3,631 · 10th to 90th $617 to $8,318Professionalmedian $229 · 10th to 90th $162 to $331
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 $199.53 Median $933.25 Typical High $7,244.36 | Facility | None | $199.53 | $933.25 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $177.83 Typical High $223.87 | Professional | None | $162.18 | $177.83 | $223.87 |
Ambetter Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $229.09 | Professional | None | $229.09 | $229.09 | $229.09 |
Anthem BCBS Setting Facility Modifier None Typical Low $630.96 Median $5,011.87 Typical High $9,549.93 | Facility | None | $630.96 | $5,011.87 | $9,549.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $151.36 Median $239.88 Typical High $323.59 | Professional | None | $151.36 | $239.88 | $323.59 |
CareSource Setting Facility Modifier None Typical Low $186.21 Median $186.21 Typical High $3,467.37 | Facility | None | $186.21 | $186.21 | $3,467.37 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $2,238.72 Typical High $3,801.89 | Facility | None | $549.54 | $2,238.72 | $3,801.89 |
Cigna Setting Professional Modifier None Typical Low $186.21 Median $239.88 Typical High $363.08 | Professional | None | $186.21 | $239.88 | $363.08 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $489.78 Median $3,548.13 Typical High $4,570.88 | Facility | None | $489.78 | $3,548.13 | $4,570.88 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $181.97 Median $218.78 Typical High $331.13 | Professional | None | $181.97 | $218.78 | $331.13 |
United Setting Facility Modifier None Typical Low $1,000.00 Median $3,311.31 Typical High $7,943.28 | Facility | None | $1,000.00 | $3,311.31 | $7,943.28 |
United Setting Professional Modifier None Typical Low $173.78 Median $208.93 Typical High $323.59 | Professional | None | $173.78 | $208.93 | $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 $81.28 Median $89.13 Typical High $104.71 | Professional | 52 · Reduced service | $81.28 | $89.13 | $104.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $35.48 Typical High $42.66 | Professional | 53 · Discontinued | $32.36 | $35.48 | $42.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $134.90 Typical High $158.49 | Professional | 54 · Surgery only | $123.03 | $134.90 | $158.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $26.92 Typical High $31.62 | Professional | 55 · Aftercare only | $24.55 | $26.92 | $31.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $17.78 Typical High $21.38 | Professional | 56 · Pre-op care only | $16.22 | $17.78 | $21.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $125.89 Typical High $147.91 | Professional | 78 · Unplanned return to OR | $114.82 | $125.89 | $147.91 |
Where Indiana sits
The same service costs 8.1 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 $4,634MT $570
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.