How much rates vary
Facilitymedian $437 · 10th to 90th $91 to $3,715Professionalmedian $138 · 10th to 90th $91 to $245
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 $251.19 Median $1,995.26 Typical High $10,964.78 | Facility | None | $251.19 | $1,995.26 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $141.25 Typical High $537.03 | Professional | None | $91.20 | $141.25 | $537.03 |
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 $91.20 Median $123.03 Typical High $194.98 | Professional | None | $91.20 | $123.03 | $194.98 |
Aultcare Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $309.03 | Professional | None | $309.03 | $309.03 | $309.03 |
CareSource Setting Facility Modifier None Typical Low $102.33 Median $128.82 Typical High $134.90 | Facility | None | $102.33 | $128.82 | $134.90 |
Cigna Setting Facility Modifier None Typical Low $58.88 Median $114.82 Typical High $199.53 | Facility | None | $58.88 | $114.82 | $199.53 |
Cigna Setting Professional Modifier None Typical Low $87.10 Median $138.04 Typical High $245.47 | Professional | None | $87.10 | $138.04 | $245.47 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $58.88 Median $114.82 Typical High $194.98 | Facility | None | $58.88 | $114.82 | $194.98 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $91.20 Median $134.90 Typical High $239.88 | Professional | None | $91.20 | $134.90 | $239.88 |
Molina Setting Professional Modifier None Typical Low $123.03 Median $169.82 Typical High $239.88 | Professional | None | $123.03 | $169.82 | $239.88 |
SummaCare Setting Facility Modifier None Typical Low $54.95 Median $57.54 Typical High $66.07 | Facility | None | $54.95 | $57.54 | $66.07 |
SummaCare Setting Professional Modifier None Typical Low $91.20 Median $138.04 Typical High $186.21 | Professional | None | $91.20 | $138.04 | $186.21 |
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 $87.10 Median $138.04 Typical High $257.04 | Professional | None | $87.10 | $138.04 | $257.04 |
7 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 $45.71 Median $70.79 Typical High $70.79 | Professional | 52 · Reduced service | $45.71 | $70.79 | $70.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $28.18 Typical High $28.18 | Professional | 53 · Discontinued | $18.20 | $28.18 | $28.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $107.15 Typical High $107.15 | Professional | 54 · Surgery only | $67.61 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $21.38 Typical High $21.38 | Professional | 55 · Aftercare only | $13.49 | $21.38 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $14.13 Typical High $14.13 | Professional | 56 · Pre-op care only | $9.12 | $14.13 | $14.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $100.00 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $63.10 | $100.00 | $100.00 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $154.88 Median $154.88 Typical High $154.88 | Professional | 59 · Distinct service | $154.88 | $154.88 | $154.88 |
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· 42nd of 51
$141
AK $427KY $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.