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 $416.87 Median $1,995.26 Typical High $10,964.78 | Facility | None | $416.87 | $1,995.26 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $151.36 Median $251.19 Typical High $691.83 | Professional | None | $151.36 | $251.19 | $691.83 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $1,071.52 Typical High $4,570.88 | Facility | None | $524.81 | $1,071.52 | $4,570.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $114.82 Median $141.25 Typical High $218.78 | Professional | None | $114.82 | $141.25 | $218.78 |
CareSource Setting Facility Modifier None Typical Low $190.55 Median $691.83 Typical High $891.25 | Facility | None | $190.55 | $691.83 | $891.25 |
Cigna Setting Facility Modifier None Typical Low $389.05 Median $794.33 Typical High $1,479.11 | Facility | None | $389.05 | $794.33 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $154.88 Median $257.04 Typical High $380.19 | Professional | None | $154.88 | $257.04 | $380.19 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $389.05 Median $794.33 Typical High $1,479.11 | Facility | None | $389.05 | $794.33 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $154.88 Median $257.04 Typical High $380.19 | Professional | None | $154.88 | $257.04 | $380.19 |
Molina Setting Professional Modifier None Typical Low $30.20 Median $218.78 Typical High $363.08 | Professional | None | $30.20 | $218.78 | $363.08 |
SummaCare Setting Facility Modifier None Typical Low $380.19 Median $398.11 Typical High $457.09 | Facility | None | $380.19 | $398.11 | $457.09 |
SummaCare Setting Professional Modifier None Typical Low $144.54 Median $218.78 Typical High $316.23 | Professional | None | $144.54 | $218.78 | $316.23 |
United Setting Facility Modifier None Typical Low $501.19 Median $977.24 Typical High $4,677.35 | Facility | None | $501.19 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $109.65 Median $190.55 Typical High $371.54 | Professional | None | $109.65 | $190.55 | $371.54 |
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 $75.86 Median $125.89 Typical High $134.90 | Professional | 52 · Reduced service | $75.86 | $125.89 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $50.12 Typical High $53.70 | Professional | 53 · Discontinued | $30.20 | $50.12 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $190.55 Typical High $199.53 | Professional | 54 · Surgery only | $112.20 | $190.55 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $38.02 Typical High $39.81 | Professional | 55 · Aftercare only | $22.39 | $38.02 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $25.12 Typical High $26.92 | Professional | 56 · Pre-op care only | $15.14 | $25.12 | $26.92 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $177.83 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $104.71 | $177.83 | $186.21 |
Where Ohio sits
The same service costs 4.5 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· 45th of 51
$214
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.