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 $524.81 Median $2,691.53 Typical High $10,964.78 | Facility | None | $524.81 | $2,691.53 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $190.55 Median $323.59 Typical High $1,318.26 | Professional | None | $190.55 | $323.59 | $1,318.26 |
Anthem BCBS Setting Facility Modifier None Typical Low $407.38 Median $831.76 Typical High $3,715.35 | Facility | None | $407.38 | $831.76 | $3,715.35 |
Anthem BCBS Setting Professional Modifier None Typical Low $181.97 Median $257.04 Typical High $436.52 | Professional | None | $181.97 | $257.04 | $436.52 |
CareSource Setting Facility Modifier None Typical Low $208.93 Median $269.15 Typical High $269.15 | Facility | None | $208.93 | $269.15 | $269.15 |
Cigna Setting Facility Modifier None Typical Low $213.80 Median $389.05 Typical High $1,995.26 | Facility | None | $213.80 | $389.05 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $363.08 Typical High $549.54 | Professional | None | $218.78 | $363.08 | $549.54 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $213.80 Median $389.05 Typical High $1,995.26 | Facility | None | $213.80 | $389.05 | $1,995.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $218.78 Median $363.08 Typical High $549.54 | Professional | None | $218.78 | $363.08 | $549.54 |
Molina Setting Professional Modifier None Typical Low $33.88 Median $346.74 Typical High $537.03 | Professional | None | $33.88 | $346.74 | $537.03 |
SummaCare Setting Facility Modifier None Typical Low $229.09 Median $239.88 Typical High $275.42 | Facility | None | $229.09 | $239.88 | $275.42 |
SummaCare Setting Professional Modifier None Typical Low $199.53 Median $316.23 Typical High $457.09 | Professional | None | $199.53 | $316.23 | $457.09 |
United Setting Facility Modifier None Typical Low $97.72 Median $275.42 Typical High $2,398.83 | Facility | None | $97.72 | $275.42 | $2,398.83 |
United Setting Professional Modifier None Typical Low $181.97 Median $302.00 Typical High $588.84 | Professional | None | $181.97 | $302.00 | $588.84 |
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 $95.50 Median $162.18 Typical High $162.18 | Professional | 52 · Reduced service | $95.50 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $64.57 Typical High $64.57 | Professional | 53 · Discontinued | $38.02 | $64.57 | $64.57 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $245.47 Typical High $245.47 | Professional | 54 · Surgery only | $144.54 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $48.98 Typical High $48.98 | Professional | 55 · Aftercare only | $28.84 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $32.36 Typical High $32.36 | Professional | 56 · Pre-op care only | $19.05 | $32.36 | $32.36 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $229.09 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $134.90 | $229.09 | $229.09 |
Where Ohio sits
The same service costs 3.5 times more in Alaska than in Maryland. 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· 43rd of 51
$316
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.