How much rates vary
Facilitymedian $851 · 10th to 90th $204 to $2,818Professionalmedian $138 · 10th to 90th $95 to $339
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 $109.65 Median $213.80 Typical High $794.33 | Facility | None | $109.65 | $213.80 | $794.33 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $208.93 Typical High $316.23 | Professional | None | $109.65 | $208.93 | $316.23 |
Ambetter Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $158.49 | Professional | None | $158.49 | $158.49 | $158.49 |
Anthem BCBS Setting Facility Modifier None Typical Low $204.17 Median $1,698.24 Typical High $2,884.03 | Facility | None | $204.17 | $1,698.24 | $2,884.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $93.33 Median $109.65 Typical High $154.88 | Professional | None | $93.33 | $109.65 | $154.88 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $138.04 Median $165.96 Typical High $234.42 | Professional | 50 · Both sides | $138.04 | $165.96 | $234.42 |
CareSource Setting Facility Modifier None Typical Low $120.23 Median $194.98 Typical High $812.83 | Facility | None | $120.23 | $194.98 | $812.83 |
CareSource Setting Professional Modifier None Typical Low $131.83 Median $162.18 Typical High $199.53 | Professional | None | $131.83 | $162.18 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $204.17 Median $562.34 Typical High $1,318.26 | Facility | None | $204.17 | $562.34 | $1,318.26 |
Cigna Setting Professional Modifier None Typical Low $123.03 Median $239.88 Typical High $1,513.56 | Professional | None | $123.03 | $239.88 | $1,513.56 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $125.89 | Professional | None | $33.11 | $33.11 | $125.89 |
United Setting Facility Modifier None Typical Low $323.59 Median $588.84 Typical High $1,621.81 | Facility | None | $323.59 | $588.84 | $1,621.81 |
United Setting Professional Modifier None Typical Low $125.89 Median $229.09 Typical High $389.05 | Professional | None | $125.89 | $229.09 | $389.05 |
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 $53.70 Median $104.71 Typical High $141.25 | Facility | 52 · Reduced service | $53.70 | $104.71 | $141.25 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $21.88 Median $41.69 Typical High $57.54 | Facility | 53 · Discontinued | $21.88 | $41.69 | $57.54 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $81.28 Median $158.49 Typical High $213.80 | Facility | 54 · Surgery only | $81.28 | $158.49 | $213.80 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $16.22 Median $31.62 Typical High $42.66 | Facility | 55 · Aftercare only | $16.22 | $31.62 | $42.66 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $10.96 Median $20.89 Typical High $28.84 | Facility | 56 · Pre-op care only | $10.96 | $20.89 | $28.84 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $53.70 Median $104.71 Typical High $123.03 | Professional | 52 · Reduced service | $53.70 | $104.71 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $41.69 Typical High $48.98 | Professional | 53 · Discontinued | $21.88 | $41.69 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $158.49 Typical High $186.21 | Professional | 54 · Surgery only | $81.28 | $158.49 | $186.21 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $31.62 Typical High $37.15 | Professional | 55 · Aftercare only | $16.22 | $31.62 | $37.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $20.89 Typical High $24.55 | Professional | 56 · Pre-op care only | $10.96 | $20.89 | $24.55 |
Where Kentucky sits
The same service costs 4.6 times more in New York 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
NY $2,775MT $606
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.