How much rates vary
Facilitymedian $427 · 10th to 90th $81 to $3,715Professionalmedian $81 · 10th to 90th $45 to $162
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 $81.28 Median $288.40 Typical High $10,715.19 | Facility | None | $81.28 | $288.40 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $35.48 Median $81.28 Typical High $288.40 | Professional | None | $35.48 | $81.28 | $288.40 |
Ambetter Setting Professional Modifier None Typical Low $46.77 Median $58.88 Typical High $58.88 | Professional | None | $46.77 | $58.88 | $58.88 |
Anthem BCBS Setting Facility Modifier None Typical Low $371.54 Median $794.33 Typical High $3,311.31 | Facility | None | $371.54 | $794.33 | $3,311.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $39.81 Median $47.86 Typical High $83.18 | Professional | None | $39.81 | $47.86 | $83.18 |
CareSource Setting Facility Modifier None Typical Low $75.86 Median $83.18 Typical High $97.72 | Facility | None | $75.86 | $83.18 | $97.72 |
Cigna Setting Facility Modifier None Typical Low $77.62 Median $138.04 Typical High $1,479.11 | Facility | None | $77.62 | $138.04 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $44.67 Median $85.11 Typical High $162.18 | Professional | None | $44.67 | $85.11 | $162.18 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $77.62 Median $138.04 Typical High $1,479.11 | Facility | None | $77.62 | $138.04 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $44.67 Median $85.11 Typical High $162.18 | Professional | None | $44.67 | $85.11 | $162.18 |
Molina Setting Professional Modifier None Typical Low $72.44 Median $120.23 Typical High $162.18 | Professional | None | $72.44 | $120.23 | $162.18 |
SummaCare Setting Facility Modifier None Typical Low $40.74 Median $42.66 Typical High $48.98 | Facility | None | $40.74 | $42.66 | $48.98 |
SummaCare Setting Professional Modifier None Typical Low $61.66 Median $117.49 Typical High $169.82 | Professional | None | $61.66 | $117.49 | $169.82 |
United Setting Facility Modifier None Typical Low $97.72 Median $275.42 Typical High $2,398.83 | Facility | None | $97.72 | $275.42 | $2,398.83 |
United Setting Professional Modifier None Typical Low $44.67 Median $75.86 Typical High $154.88 | Professional | None | $44.67 | $75.86 | $154.88 |
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 $17.78 Median $40.74 Typical High $44.67 | Professional | 52 · Reduced service | $17.78 | $40.74 | $44.67 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.08 Median $16.22 Typical High $18.20 | Professional | 53 · Discontinued | $7.08 | $16.22 | $18.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $26.92 Median $60.26 Typical High $67.61 | Professional | 54 · Surgery only | $26.92 | $60.26 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.37 Median $12.30 Typical High $13.49 | Professional | 55 · Aftercare only | $5.37 | $12.30 | $13.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.55 Median $8.13 Typical High $9.12 | Professional | 56 · Pre-op care only | $3.55 | $8.13 | $9.12 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $70.79 Median $70.79 Typical High $70.79 | Professional | 59 · Distinct service | $70.79 | $70.79 | $70.79 |
Where Ohio sits
The same service costs 16.4 times more in Connecticut than in Kentucky. 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
CT $2,728KY $166
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.