How much rates vary
Facilitymedian $3,631 · 10th to 90th $1,000 to $12,023Professionalmedian $871 · 10th to 90th $89 to $1,349
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 $3,019.95 Median $8,317.64 Typical High $13,182.57 | Facility | None | $3,019.95 | $8,317.64 | $13,182.57 |
Aetna Setting Professional Modifier None Typical Low $1,122.02 Median $1,122.02 Typical High $10,000.00 | Professional | None | $1,122.02 | $1,122.02 | $10,000.00 |
Anthem BCBS Setting Facility Modifier None Typical Low $954.99 Median $2,344.23 Typical High $7,943.28 | Facility | None | $954.99 | $2,344.23 | $7,943.28 |
Anthem BCBS Setting Professional Modifier None Typical Low $812.83 Median $954.99 Typical High $1,548.82 | Professional | None | $812.83 | $954.99 | $1,548.82 |
CareSource Setting Facility Modifier None Typical Low $1,348.96 Median $2,511.89 Typical High $3,311.31 | Facility | None | $1,348.96 | $2,511.89 | $3,311.31 |
CareSource Setting Professional Modifier None Typical Low $1,148.15 Median $1,148.15 Typical High $1,148.15 | Professional | None | $1,148.15 | $1,148.15 | $1,148.15 |
Cigna Setting Professional Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,318.26 | Professional | None | $1,230.27 | $1,230.27 | $1,318.26 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $2,344.23 Median $2,344.23 Typical High $2,344.23 | Facility | None | $2,344.23 | $2,344.23 | $2,344.23 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1,698.24 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,698.24 | $1,698.24 | $1,698.24 |
Molina Setting Professional Modifier None Typical Low $69.18 Median $676.08 Typical High $1,148.15 | Professional | None | $69.18 | $676.08 | $1,148.15 |
SummaCare Setting Facility Modifier None Typical Low $1,445.44 Median $1,513.56 Typical High $1,698.24 | Facility | None | $1,445.44 | $1,513.56 | $1,698.24 |
SummaCare Setting Professional Modifier None Typical Low $1,000.00 Median $1,000.00 Typical High $1,479.11 | Professional | None | $1,000.00 | $1,000.00 | $1,479.11 |
United Setting Facility Modifier None Typical Low $851.14 Median $3,467.37 Typical High $9,120.11 | Facility | None | $851.14 | $3,467.37 | $9,120.11 |
United Setting Professional Modifier None Typical Low $912.01 Median $1,122.02 Typical High $2,041.74 | Professional | None | $912.01 | $1,122.02 | $2,041.74 |
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 $562.34 Median $562.34 Typical High $2,041.74 | Professional | 52 · Reduced service | $562.34 | $562.34 | $2,041.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $223.87 Typical High $812.83 | Professional | 53 · Discontinued | $223.87 | $223.87 | $812.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $851.14 Typical High $3,019.95 | Professional | 54 · Surgery only | $851.14 | $851.14 | $3,019.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $169.82 Typical High $602.56 | Professional | 55 · Aftercare only | $169.82 | $169.82 | $602.56 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $112.20 Typical High $407.38 | Professional | 56 · Pre-op care only | $112.20 | $112.20 | $407.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $794.33 Typical High $2,818.38 | Professional | 78 · Unplanned return to OR | $794.33 | $794.33 | $2,818.38 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,202.26 Median $1,412.54 Typical High $2,290.87 | Professional | 50 · Both sides | $1,202.26 | $1,412.54 | $2,290.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $512.86 Median $602.56 Typical High $977.24 | Professional | 62 · Two surgeons | $512.86 | $602.56 | $977.24 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $128.82 Median $151.36 Typical High $269.15 | Professional | 80 · Assistant surgeon | $128.82 | $151.36 | $269.15 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $112.20 Median $131.83 Typical High $218.78 | Professional | AS · PA/NP assist | $112.20 | $131.83 | $218.78 |
Where Ohio sits
The same service costs 3.7 times more in Wisconsin 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
WI $12,177MT $3,320
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.