How much rates vary
Facilitymedian $2,188 · 10th to 90th $355 to $9,550Professionalmedian $324 · 10th to 90th $200 to $537
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 $354.81 Typical High $758.58 | Facility | None | $199.53 | $354.81 | $758.58 |
Aetna Setting Professional Modifier None Typical Low $199.53 Median $354.81 Typical High $549.54 | Professional | None | $199.53 | $354.81 | $549.54 |
Ambetter Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $257.04 | Professional | None | $245.47 | $245.47 | $257.04 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,202.26 Median $3,715.35 Typical High $10,715.19 | Facility | None | $1,202.26 | $3,715.35 | $10,715.19 |
Anthem BCBS Setting Professional Modifier None Typical Low $199.53 Median $302.00 Typical High $416.87 | Professional | None | $199.53 | $302.00 | $416.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $125.89 Median $190.55 Typical High $269.15 | Professional | 62 · Two surgeons | $125.89 | $190.55 | $269.15 |
CareSource Setting Facility Modifier None Typical Low $199.53 Median $331.13 Typical High $2,818.38 | Facility | None | $199.53 | $331.13 | $2,818.38 |
CareSource Setting Professional Modifier None Typical Low $204.17 Median $288.40 Typical High $338.84 | Professional | None | $204.17 | $288.40 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $346.74 Median $1,862.09 Typical High $2,137.96 | Facility | None | $346.74 | $1,862.09 | $2,137.96 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $398.11 Typical High $1,905.46 | Professional | None | $208.93 | $398.11 | $1,905.46 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
United Setting Facility Modifier None Typical Low $707.95 Median $1,288.25 Typical High $3,890.45 | Facility | None | $707.95 | $1,288.25 | $3,890.45 |
United Setting Professional Modifier None Typical Low $275.42 Median $407.38 Typical High $616.60 | Professional | None | $275.42 | $407.38 | $616.60 |
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 Facility Modifier 52 · Reduced service Typical Low $100.00 Median $177.83 Typical High $199.53 | Facility | 52 · Reduced service | $100.00 | $177.83 | $199.53 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $39.81 Median $70.79 Typical High $79.43 | Facility | 53 · Discontinued | $39.81 | $70.79 | $79.43 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $147.91 Median $263.03 Typical High $295.12 | Facility | 54 · Surgery only | $147.91 | $263.03 | $295.12 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $29.51 Median $52.48 Typical High $58.88 | Facility | 55 · Aftercare only | $29.51 | $52.48 | $58.88 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $19.95 Median $35.48 Typical High $39.81 | Facility | 56 · Pre-op care only | $19.95 | $35.48 | $39.81 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $100.00 Median $173.78 Typical High $204.17 | Professional | 52 · Reduced service | $100.00 | $173.78 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $69.18 Typical High $81.28 | Professional | 53 · Discontinued | $39.81 | $69.18 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $257.04 Typical High $309.03 | Professional | 54 · Surgery only | $147.91 | $257.04 | $309.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $51.29 Typical High $61.66 | Professional | 55 · Aftercare only | $29.51 | $51.29 | $61.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $34.67 Typical High $40.74 | Professional | 56 · Pre-op care only | $19.95 | $34.67 | $40.74 |
Where Kentucky sits
The same service costs 5.9 times more in Oklahoma than in West Virginia. 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 $4,893WV $835
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.