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 $3,235.94 Typical High $12,589.25 | Facility | None | $524.81 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $208.93 Typical High $2,089.30 | Professional | None | $144.54 | $208.93 | $2,089.30 |
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 $131.83 Median $204.17 Typical High $316.23 | Professional | None | $131.83 | $204.17 | $316.23 |
CareSource Setting Facility Modifier None Typical Low $138.04 Median $181.97 Typical High $204.17 | Facility | None | $138.04 | $181.97 | $204.17 |
Cigna Setting Facility Modifier None Typical Low $141.25 Median $251.19 Typical High $1,479.11 | Facility | None | $141.25 | $251.19 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $141.25 Median $204.17 Typical High $380.19 | Professional | None | $141.25 | $204.17 | $380.19 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $141.25 Median $251.19 Typical High $1,479.11 | Facility | None | $141.25 | $251.19 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $141.25 Median $204.17 Typical High $380.19 | Professional | None | $141.25 | $204.17 | $380.19 |
Molina Setting Professional Modifier None Typical Low $162.18 Median $223.87 Typical High $323.59 | Professional | None | $162.18 | $223.87 | $323.59 |
SummaCare Setting Facility Modifier None Typical Low $75.86 Median $79.43 Typical High $89.13 | Facility | None | $75.86 | $79.43 | $89.13 |
SummaCare Setting Professional Modifier None Typical Low $141.25 Median $213.80 Typical High $281.84 | Professional | None | $141.25 | $213.80 | $281.84 |
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 $141.25 Median $213.80 Typical High $389.05 | Professional | None | $141.25 | $213.80 | $389.05 |
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 $72.44 Median $104.71 Typical High $112.20 | Professional | 52 · Reduced service | $72.44 | $104.71 | $112.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $41.69 Typical High $44.67 | Professional | 53 · Discontinued | $28.84 | $41.69 | $44.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $158.49 Typical High $165.96 | Professional | 54 · Surgery only | $107.15 | $158.49 | $165.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $31.62 Typical High $33.11 | Professional | 55 · Aftercare only | $21.88 | $31.62 | $33.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $20.89 Typical High $22.39 | Professional | 56 · Pre-op care only | $14.45 | $20.89 | $22.39 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $147.91 Typical High $154.88 | Professional | 78 · Unplanned return to OR | $100.00 | $147.91 | $154.88 |
Where Ohio sits
The same service costs 3.5 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· 45th of 51
$209
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.