How much rates vary
Facilitymedian $4,074 · 10th to 90th $1,072 to $10,965Professionalmedian $977 · 10th to 90th $148 to $1,549
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 $2,754.23 Median $7,079.46 Typical High $12,589.25 | Facility | None | $2,754.23 | $7,079.46 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $1,000.00 Median $1,000.00 Typical High $8,912.51 | Professional | None | $1,000.00 | $1,000.00 | $8,912.51 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,096.48 Median $3,981.07 Typical High $12,022.64 | Facility | None | $1,096.48 | $3,981.07 | $12,022.64 |
Anthem BCBS Setting Professional Modifier None Typical Low $851.14 Median $1,047.13 Typical High $1,737.80 | Professional | None | $851.14 | $1,047.13 | $1,737.80 |
CareSource Setting Facility Modifier None Typical Low $1,380.38 Median $3,388.44 Typical High $4,365.16 | Facility | None | $1,380.38 | $3,388.44 | $4,365.16 |
Cigna Setting Facility Modifier None Typical Low $794.33 Median $3,890.45 Typical High $7,079.46 | Facility | None | $794.33 | $3,890.45 | $7,079.46 |
Cigna Setting Professional Modifier None Typical Low $1,122.02 Median $1,513.56 Typical High $2,089.30 | Professional | None | $1,122.02 | $1,513.56 | $2,089.30 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $794.33 Median $3,890.45 Typical High $7,079.46 | Facility | None | $794.33 | $3,890.45 | $7,079.46 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1,122.02 Median $1,513.56 Typical High $2,089.30 | Professional | None | $1,122.02 | $1,513.56 | $2,089.30 |
Molina Setting Professional Modifier None Typical Low $134.90 Median $812.83 Typical High $1,380.38 | Professional | None | $134.90 | $812.83 | $1,380.38 |
SummaCare Setting Facility Modifier None Typical Low $1,905.46 Median $1,995.26 Typical High $2,290.87 | Facility | None | $1,905.46 | $1,995.26 | $2,290.87 |
SummaCare Setting Professional Modifier None Typical Low $977.24 Median $1,071.52 Typical High $1,412.54 | Professional | None | $977.24 | $1,071.52 | $1,412.54 |
United Setting Facility Modifier None Typical Low $912.01 Median $3,388.44 Typical High $12,022.64 | Facility | None | $912.01 | $3,388.44 | $12,022.64 |
United Setting Professional Modifier None Typical Low $724.44 Median $1,202.26 Typical High $2,089.30 | Professional | None | $724.44 | $1,202.26 | $2,089.30 |
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 Professional Modifier 52 · Reduced service Typical Low $489.78 Median $489.78 Typical High $3,801.89 | Professional | 52 · Reduced service | $489.78 | $489.78 | $3,801.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $199.53 Typical High $1,548.82 | Professional | 53 · Discontinued | $199.53 | $199.53 | $1,548.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $741.31 Typical High $5,754.40 | Professional | 54 · Surgery only | $741.31 | $741.31 | $5,754.40 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $147.91 Typical High $1,148.15 | Professional | 55 · Aftercare only | $147.91 | $147.91 | $1,148.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $100.00 Typical High $758.58 | Professional | 56 · Pre-op care only | $100.00 | $100.00 | $758.58 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $691.83 Typical High $5,370.32 | Professional | 78 · Unplanned return to OR | $691.83 | $691.83 | $5,370.32 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,258.93 Median $1,584.89 Typical High $2,570.40 | Professional | 50 · Both sides | $1,258.93 | $1,584.89 | $2,570.40 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $537.03 Median $660.69 Typical High $1,096.48 | Professional | 62 · Two surgeons | $537.03 | $660.69 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $134.90 Median $169.82 Typical High $281.84 | Professional | 80 · Assistant surgeon | $134.90 | $169.82 | $281.84 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $117.49 Median $147.91 Typical High $245.47 | Professional | AS · PA/NP assist | $117.49 | $147.91 | $245.47 |
Where Ohio sits
The same service costs 5.0 times more in Colorado 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
CO $14,731KY $2,968
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.