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 $457.09 Median $10,232.93 Typical High $13,803.84 | Facility | None | $457.09 | $10,232.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $354.81 Median $457.09 Typical High $1,047.13 | Professional | None | $354.81 | $457.09 | $1,047.13 |
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 $316.23 Median $436.52 Typical High $707.95 | Professional | None | $316.23 | $436.52 | $707.95 |
CareSource Setting Facility Modifier None Typical Low $316.23 Median $416.87 Typical High $501.19 | Facility | None | $316.23 | $416.87 | $501.19 |
Cigna Setting Facility Modifier None Typical Low $58.88 Median $371.54 Typical High $630.96 | Facility | None | $58.88 | $371.54 | $630.96 |
Cigna Setting Professional Modifier None Typical Low $331.13 Median $457.09 Typical High $912.01 | Professional | None | $331.13 | $457.09 | $912.01 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $58.88 Median $371.54 Typical High $630.96 | Facility | None | $58.88 | $371.54 | $630.96 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $331.13 Median $457.09 Typical High $912.01 | Professional | None | $331.13 | $457.09 | $912.01 |
Molina Setting Professional Modifier None Typical Low $36.31 Median $338.84 Typical High $630.96 | Professional | None | $36.31 | $338.84 | $630.96 |
SummaCare Setting Facility Modifier None Typical Low $181.97 Median $190.55 Typical High $213.80 | Facility | None | $181.97 | $190.55 | $213.80 |
SummaCare Setting Professional Modifier None Typical Low $363.08 Median $524.81 Typical High $602.56 | Professional | None | $363.08 | $524.81 | $602.56 |
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 $338.84 Median $501.19 Typical High $870.96 | Professional | None | $338.84 | $501.19 | $870.96 |
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 $177.83 Median $229.09 Typical High $245.47 | Professional | 52 · Reduced service | $177.83 | $229.09 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $70.79 Median $91.20 Typical High $97.72 | Professional | 53 · Discontinued | $70.79 | $91.20 | $97.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $263.03 Median $338.84 Typical High $363.08 | Professional | 54 · Surgery only | $263.03 | $338.84 | $363.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $52.48 Median $67.61 Typical High $72.44 | Professional | 55 · Aftercare only | $52.48 | $67.61 | $72.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $35.48 Median $45.71 Typical High $48.98 | Professional | 56 · Pre-op care only | $35.48 | $45.71 | $48.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $245.47 Median $316.23 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $245.47 | $316.23 | $338.84 |
Where Ohio sits
The same service costs 5.1 times more in Alaska than in Texas. 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· 48th of 51
$427
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.