How much rates vary
Facilitymedian $1,072 · 10th to 90th $457 to $4,898Professionalmedian $347 · 10th to 90th $48 to $603
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 $316.23 Median $1,096.48 Typical High $10,232.93 | Facility | None | $316.23 | $1,096.48 | $10,232.93 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $380.19 Typical High $1,096.48 | Professional | None | $169.82 | $380.19 | $1,096.48 |
Ambetter Setting Professional Modifier None Typical Low $169.82 Median $169.82 Typical High $426.58 | Professional | None | $169.82 | $169.82 | $426.58 |
Anthem BCBS Setting Facility Modifier None Typical Low $489.78 Median $1,122.02 Typical High $4,570.88 | Facility | None | $489.78 | $1,122.02 | $4,570.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $186.21 Median $234.42 Typical High $346.74 | Professional | None | $186.21 | $234.42 | $346.74 |
CareSource Setting Facility Modifier None Typical Low $234.42 Median $891.25 Typical High $1,174.90 | Facility | None | $234.42 | $891.25 | $1,174.90 |
CareSource Setting Professional Modifier None Typical Low $389.05 Median $489.78 Typical High $602.56 | Professional | None | $389.05 | $489.78 | $602.56 |
Cigna Setting Facility Modifier None Typical Low $512.86 Median $1,000.00 Typical High $1,659.59 | Facility | None | $512.86 | $1,000.00 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $239.88 Median $416.87 Typical High $630.96 | Professional | None | $239.88 | $416.87 | $630.96 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $512.86 Median $1,047.13 Typical High $2,137.96 | Facility | None | $512.86 | $1,047.13 | $2,137.96 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $239.88 Median $407.38 Typical High $616.60 | Professional | None | $239.88 | $407.38 | $616.60 |
Molina Setting Professional Modifier None Typical Low $32.36 Median $371.54 Typical High $588.84 | Professional | None | $32.36 | $371.54 | $588.84 |
SummaCare Setting Facility Modifier None Typical Low $489.78 Median $512.86 Typical High $588.84 | Facility | None | $489.78 | $512.86 | $588.84 |
SummaCare Setting Professional Modifier None Typical Low $177.83 Median $389.05 Typical High $467.74 | Professional | None | $177.83 | $389.05 | $467.74 |
United Setting Facility Modifier None Typical Low $691.83 Median $1,445.44 Typical High $5,888.44 | Facility | None | $691.83 | $1,445.44 | $5,888.44 |
United Setting Professional Modifier None Typical Low $177.83 Median $354.81 Typical High $707.95 | Professional | None | $177.83 | $354.81 | $707.95 |
8 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 $85.11 Median $190.55 Typical High $218.78 | Professional | 52 · Reduced service | $85.11 | $190.55 | $218.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $75.86 Typical High $87.10 | Professional | 53 · Discontinued | $33.88 | $75.86 | $87.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $281.84 Typical High $331.13 | Professional | 54 · Surgery only | $128.82 | $281.84 | $331.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $56.23 Typical High $66.07 | Professional | 55 · Aftercare only | $25.70 | $56.23 | $66.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $38.02 Typical High $43.65 | Professional | 56 · Pre-op care only | $16.98 | $38.02 | $43.65 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $263.03 Typical High $309.03 | Professional | 78 · Unplanned return to OR | $120.23 | $263.03 | $309.03 |
Ambetter Setting Professional Modifier 50 · Both sides Typical Low $302.00 Median $302.00 Typical High $602.56 | Professional | 50 · Both sides | $302.00 | $302.00 | $602.56 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $281.84 Median $354.81 Typical High $524.81 | Professional | 50 · Both sides | $281.84 | $354.81 | $524.81 |
Where Ohio sits
The same service costs 4.6 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 $4,728MT $1,029
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.