How much rates vary
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 $257.04 Median $1,995.26 Typical High $10,964.78 | Facility | None | $257.04 | $1,995.26 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $77.62 Median $257.04 Typical High $2,630.27 | Professional | None | $77.62 | $257.04 | $2,630.27 |
Anthem BCBS Setting Facility Modifier None Typical Low $371.54 Median $794.33 Typical High $3,311.31 | Facility | None | $371.54 | $794.33 | $3,311.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $87.10 Median $208.93 Typical High $407.38 | Professional | None | $87.10 | $208.93 | $407.38 |
CareSource Setting Facility Modifier None Typical Low $109.65 Median $109.65 Typical High $109.65 | Facility | None | $109.65 | $109.65 | $109.65 |
Cigna Setting Facility Modifier None Typical Low $263.03 Median $416.87 Typical High $1,479.11 | Facility | None | $263.03 | $416.87 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $281.84 Typical High $512.86 | Professional | None | $93.33 | $281.84 | $512.86 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $263.03 Median $416.87 Typical High $1,479.11 | Facility | None | $263.03 | $416.87 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $93.33 Median $281.84 Typical High $524.81 | Professional | None | $93.33 | $281.84 | $524.81 |
Molina Setting Professional Modifier None Typical Low $302.00 Median $407.38 Typical High $549.54 | Professional | None | $302.00 | $407.38 | $549.54 |
SummaCare Setting Facility Modifier None Typical Low $144.54 Median $151.36 Typical High $169.82 | Facility | None | $144.54 | $151.36 | $169.82 |
SummaCare Setting Professional Modifier None Typical Low $83.18 Median $245.47 Typical High $416.87 | Professional | None | $83.18 | $245.47 | $416.87 |
United Setting Facility Modifier None Typical Low $363.08 Median $691.83 Typical High $3,311.31 | Facility | None | $363.08 | $691.83 | $3,311.31 |
United Setting Professional Modifier None Typical Low $87.10 Median $234.42 Typical High $501.19 | Professional | None | $87.10 | $234.42 | $501.19 |
5 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 $38.90 Median $125.89 Typical High $134.90 | Professional | 52 · Reduced service | $38.90 | $125.89 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.49 Median $51.29 Typical High $53.70 | Professional | 53 · Discontinued | $15.49 | $51.29 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $58.88 Median $190.55 Typical High $204.17 | Professional | 54 · Surgery only | $58.88 | $190.55 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.75 Median $38.02 Typical High $40.74 | Professional | 55 · Aftercare only | $11.75 | $38.02 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $25.70 Typical High $26.92 | Professional | 56 · Pre-op care only | $7.76 | $25.70 | $26.92 |
Where Ohio sits
The same service costs 4.3 times more in Oklahoma than in Nebraska. 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· 37th of 51
$282
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.