How much rates vary
Facilitymedian $1,000 · 10th to 90th $263 to $7,762Professionalmedian $269 · 10th to 90th $54 to $427
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 $891.25 Median $7,079.46 Typical High $12,589.25 | Facility | None | $891.25 | $7,079.46 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $199.53 Median $309.03 Typical High $4,168.69 | Professional | None | $199.53 | $309.03 | $4,168.69 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $1,071.52 Typical High $4,570.88 | Facility | None | $524.81 | $1,071.52 | $4,570.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $173.78 Median $302.00 Typical High $426.58 | Professional | None | $173.78 | $302.00 | $426.58 |
CareSource Setting Facility Modifier None Typical Low $218.78 Median $234.42 Typical High $281.84 | Facility | None | $218.78 | $234.42 | $281.84 |
CareSource Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $199.53 | Professional | None | $199.53 | $199.53 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $239.88 Median $354.81 Typical High $1,479.11 | Facility | None | $239.88 | $354.81 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $177.83 Median $295.12 Typical High $549.54 | Professional | None | $177.83 | $295.12 | $549.54 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $239.88 Median $354.81 Typical High $1,479.11 | Facility | None | $239.88 | $354.81 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $177.83 Median $295.12 Typical High $575.44 | Professional | None | $177.83 | $295.12 | $575.44 |
Molina Setting Professional Modifier None Typical Low $30.90 Median $234.42 Typical High $380.19 | Professional | None | $30.90 | $234.42 | $380.19 |
SummaCare Setting Facility Modifier None Typical Low $125.89 Median $131.83 Typical High $151.36 | Facility | None | $125.89 | $131.83 | $151.36 |
SummaCare Setting Professional Modifier None Typical Low $177.83 Median $309.03 Typical High $363.08 | Professional | None | $177.83 | $309.03 | $363.08 |
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 $190.55 Median $288.40 Typical High $478.63 | Professional | None | $190.55 | $288.40 | $478.63 |
7 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 $97.72 Median $154.88 Typical High $154.88 | Professional | 52 · Reduced service | $97.72 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $61.66 Typical High $61.66 | Professional | 53 · Discontinued | $39.81 | $61.66 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $229.09 Typical High $229.09 | Professional | 54 · Surgery only | $147.91 | $229.09 | $229.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $46.77 Typical High $46.77 | Professional | 55 · Aftercare only | $29.51 | $46.77 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $30.90 Typical High $30.90 | Professional | 56 · Pre-op care only | $19.95 | $30.90 | $30.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $213.80 Typical High $213.80 | Professional | 78 · Unplanned return to OR | $138.04 | $213.80 | $213.80 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $263.03 Median $446.68 Typical High $645.65 | Professional | 50 · Both sides | $263.03 | $446.68 | $645.65 |
Where Ohio sits
The same service costs 4.3 times more in Wyoming than in Utah. 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.
Ohio· 42nd of 51
$288
WY $933UT $219
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.