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 $426.58 Median $3,235.94 Typical High $12,589.25 | Facility | None | $426.58 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $107.15 Median $169.82 Typical High $2,344.23 | Professional | None | $107.15 | $169.82 | $2,344.23 |
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 $81.28 Median $138.04 Typical High $229.09 | Professional | None | $81.28 | $138.04 | $229.09 |
CareSource Setting Facility Modifier None Typical Low $125.89 Median $151.36 Typical High $165.96 | Facility | None | $125.89 | $151.36 | $165.96 |
Cigna Setting Facility Modifier None Typical Low $134.90 Median $239.88 Typical High $1,479.11 | Facility | None | $134.90 | $239.88 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $100.00 Median $165.96 Typical High $295.12 | Professional | None | $100.00 | $165.96 | $295.12 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $134.90 Median $239.88 Typical High $1,479.11 | Facility | None | $134.90 | $239.88 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $100.00 Median $165.96 Typical High $295.12 | Professional | None | $100.00 | $165.96 | $295.12 |
Molina Setting Professional Modifier None Typical Low $128.82 Median $186.21 Typical High $275.42 | Professional | None | $128.82 | $186.21 | $275.42 |
SummaCare Setting Facility Modifier None Typical Low $72.44 Median $75.86 Typical High $85.11 | Facility | None | $72.44 | $75.86 | $85.11 |
SummaCare Setting Professional Modifier None Typical Low $109.65 Median $165.96 Typical High $229.09 | Professional | None | $109.65 | $165.96 | $229.09 |
United Setting Facility Modifier None Typical Low $363.08 Median $691.83 Typical High $3,388.44 | Facility | None | $363.08 | $691.83 | $3,388.44 |
United Setting Professional Modifier None Typical Low $97.72 Median $162.18 Typical High $309.03 | Professional | None | $97.72 | $162.18 | $309.03 |
6 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 $53.70 Median $85.11 Typical High $85.11 | Professional | 52 · Reduced service | $53.70 | $85.11 | $85.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $33.88 Typical High $33.88 | Professional | 53 · Discontinued | $21.38 | $33.88 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $125.89 Typical High $125.89 | Professional | 54 · Surgery only | $79.43 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $25.12 Typical High $25.12 | Professional | 55 · Aftercare only | $15.85 | $25.12 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.72 Median $16.98 Typical High $16.98 | Professional | 56 · Pre-op care only | $10.72 | $16.98 | $16.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $117.49 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $74.13 | $117.49 | $117.49 |
Where Ohio sits
The same service costs 3.6 times more in Alaska than in Kentucky. 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· 45th of 51
$166
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.