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 $295.12 Median $3,235.94 Typical High $12,589.25 | Facility | None | $295.12 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $83.18 Median $128.82 Typical High $478.63 | Professional | None | $83.18 | $128.82 | $478.63 |
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 $75.86 Median $112.20 Typical High $177.83 | Professional | None | $75.86 | $112.20 | $177.83 |
CareSource Setting Facility Modifier None Typical Low $93.33 Median $117.49 Typical High $120.23 | Facility | None | $93.33 | $117.49 | $120.23 |
Cigna Setting Facility Modifier None Typical Low $58.88 Median $104.71 Typical High $190.55 | Facility | None | $58.88 | $104.71 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $123.03 Typical High $223.87 | Professional | None | $79.43 | $123.03 | $223.87 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $58.88 Median $104.71 Typical High $177.83 | Facility | None | $58.88 | $104.71 | $177.83 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $79.43 Median $123.03 Typical High $223.87 | Professional | None | $79.43 | $123.03 | $223.87 |
Molina Setting Professional Modifier None Typical Low $93.33 Median $128.82 Typical High $190.55 | Professional | None | $93.33 | $128.82 | $190.55 |
SummaCare Setting Facility Modifier None Typical Low $51.29 Median $53.70 Typical High $60.26 | Facility | None | $51.29 | $53.70 | $60.26 |
SummaCare Setting Professional Modifier None Typical Low $83.18 Median $125.89 Typical High $169.82 | Professional | None | $83.18 | $125.89 | $169.82 |
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 $79.43 Median $125.89 Typical High $239.88 | Professional | None | $79.43 | $125.89 | $239.88 |
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 $41.69 Median $63.10 Typical High $64.57 | Professional | 52 · Reduced service | $41.69 | $63.10 | $64.57 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $25.70 Typical High $25.70 | Professional | 53 · Discontinued | $16.60 | $25.70 | $25.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $95.50 Typical High $97.72 | Professional | 54 · Surgery only | $61.66 | $95.50 | $97.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $19.05 Typical High $19.50 | Professional | 55 · Aftercare only | $12.30 | $19.05 | $19.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $12.88 Typical High $12.88 | Professional | 56 · Pre-op care only | $8.32 | $12.88 | $12.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $57.54 Median $89.13 Typical High $91.20 | Professional | 78 · Unplanned return to OR | $57.54 | $89.13 | $91.20 |
Where Ohio sits
The same service costs 3.5 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· 46th of 51
$123
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.