How much rates vary
Facilitymedian $1,202 · 10th to 90th $525 to $5,754Professionalmedian $263 · 10th to 90th $48 to $447
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 $489.78 Median $2,691.53 Typical High $10,964.78 | Facility | None | $489.78 | $2,691.53 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $181.97 Median $323.59 Typical High $1,096.48 | Professional | None | $181.97 | $323.59 | $1,096.48 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $1,148.15 Typical High $4,466.84 | Facility | None | $524.81 | $1,148.15 | $4,466.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $158.49 Median $263.03 Typical High $380.19 | Professional | None | $158.49 | $263.03 | $380.19 |
CareSource Setting Facility Modifier None Typical Low $218.78 Median $1,000.00 Typical High $1,288.25 | Facility | None | $218.78 | $1,000.00 | $1,288.25 |
CareSource Setting Professional Modifier None Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | None | $186.21 | $186.21 | $186.21 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $1,148.15 Typical High $1,995.26 | Facility | None | $489.78 | $1,148.15 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $269.15 Typical High $478.63 | Professional | None | $158.49 | $269.15 | $478.63 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $512.86 Median $1,148.15 Typical High $1,995.26 | Facility | None | $512.86 | $1,148.15 | $1,995.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $158.49 Median $269.15 Typical High $457.09 | Professional | None | $158.49 | $269.15 | $457.09 |
Molina Setting Professional Modifier None Typical Low $30.20 Median $245.47 Typical High $398.11 | Professional | None | $30.20 | $245.47 | $398.11 |
SummaCare Setting Facility Modifier None Typical Low $562.34 Median $588.84 Typical High $660.69 | Facility | None | $562.34 | $588.84 | $660.69 |
SummaCare Setting Professional Modifier None Typical Low $158.49 Median $323.59 Typical High $380.19 | Professional | None | $158.49 | $323.59 | $380.19 |
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 $162.18 Median $281.84 Typical High $457.09 | Professional | None | $162.18 | $281.84 | $457.09 |
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 $91.20 Median $162.18 Typical High $162.18 | Professional | 52 · Reduced service | $91.20 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $36.31 Median $64.57 Typical High $64.57 | Professional | 53 · Discontinued | $36.31 | $64.57 | $64.57 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $245.47 Typical High $245.47 | Professional | 54 · Surgery only | $134.90 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $48.98 Typical High $48.98 | Professional | 55 · Aftercare only | $27.54 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $32.36 Typical High $32.36 | Professional | 56 · Pre-op care only | $18.20 | $32.36 | $32.36 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $229.09 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $125.89 | $229.09 | $229.09 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $239.88 Median $398.11 Typical High $575.44 | Professional | 50 · Both sides | $239.88 | $398.11 | $575.44 |
Where Ohio sits
The same service costs 6.3 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 $4,654MT $736
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.