How much rates vary
Facilitymedian $1,820 · 10th to 90th $589 to $7,244Professionalmedian $501 · 10th to 90th $372 to $832
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 $467.74 Median $588.84 Typical High $794.33 | Facility | None | $467.74 | $588.84 | $794.33 |
Aetna Setting Professional Modifier None Typical Low $446.68 Median $575.44 Typical High $645.65 | Professional | None | $446.68 | $575.44 | $645.65 |
Ambetter Setting Professional Modifier None Typical Low $575.44 Median $575.44 Typical High $575.44 | Professional | None | $575.44 | $575.44 | $575.44 |
Anthem BCBS Setting Facility Modifier None Typical Low $954.99 Median $2,884.03 Typical High $8,511.38 | Facility | None | $954.99 | $2,884.03 | $8,511.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $346.74 Median $416.87 Typical High $758.58 | Professional | None | $346.74 | $416.87 | $758.58 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $524.81 Median $630.96 Typical High $1,122.02 | Professional | 50 · Both sides | $524.81 | $630.96 | $1,122.02 |
CareSource Setting Facility Modifier None Typical Low $346.74 Median $645.65 Typical High $1,737.80 | Facility | None | $346.74 | $645.65 | $1,737.80 |
CareSource Setting Professional Modifier None Typical Low $398.11 Median $575.44 Typical High $676.08 | Professional | None | $398.11 | $575.44 | $676.08 |
Cigna Setting Facility Modifier None Typical Low $562.34 Median $1,230.27 Typical High $2,290.87 | Facility | None | $562.34 | $1,230.27 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $416.87 Median $537.03 Typical High $3,467.37 | Professional | None | $416.87 | $537.03 | $3,467.37 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
United Setting Facility Modifier None Typical Low $707.95 Median $1,174.90 Typical High $3,890.45 | Facility | None | $707.95 | $1,174.90 | $3,890.45 |
United Setting Professional Modifier None Typical Low $407.38 Median $501.19 Typical High $812.83 | Professional | None | $407.38 | $501.19 | $812.83 |
12 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 $234.42 Median $295.12 Typical High $323.59 | Facility | 52 · Reduced service | $234.42 | $295.12 | $323.59 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $93.33 Median $117.49 Typical High $131.83 | Facility | 53 · Discontinued | $93.33 | $117.49 | $131.83 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $346.74 Median $446.68 Typical High $489.78 | Facility | 54 · Surgery only | $346.74 | $446.68 | $489.78 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $69.18 Median $89.13 Typical High $97.72 | Facility | 55 · Aftercare only | $69.18 | $89.13 | $97.72 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $46.77 Median $58.88 Typical High $64.57 | Facility | 56 · Pre-op care only | $46.77 | $58.88 | $64.57 |
Aetna Setting Facility Modifier 78 · Unplanned return to OR Typical Low $323.59 Median $416.87 Typical High $457.09 | Facility | 78 · Unplanned return to OR | $323.59 | $416.87 | $457.09 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $234.42 Median $288.40 Typical High $309.03 | Professional | 52 · Reduced service | $234.42 | $288.40 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $114.82 Typical High $123.03 | Professional | 53 · Discontinued | $93.33 | $114.82 | $123.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $346.74 Median $426.58 Typical High $467.74 | Professional | 54 · Surgery only | $346.74 | $426.58 | $467.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $69.18 Median $85.11 Typical High $93.33 | Professional | 55 · Aftercare only | $69.18 | $85.11 | $93.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $57.54 Typical High $61.66 | Professional | 56 · Pre-op care only | $46.77 | $57.54 | $61.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $323.59 Median $398.11 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $323.59 | $398.11 | $436.52 |
Where Kentucky sits
The same service costs 4.0 times more in Oklahoma than in West Virginia. 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
OK $5,056WV $1,262
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.