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 $104.71 Median $10,232.93 Typical High $13,803.84 | Facility | None | $104.71 | $10,232.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $58.88 Median $104.71 Typical High $295.12 | Professional | None | $58.88 | $104.71 | $295.12 |
Anthem BCBS Setting Facility Modifier None Typical Low $380.19 Median $831.76 Typical High $3,388.44 | Facility | None | $380.19 | $831.76 | $3,388.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $47.86 Median $56.23 Typical High $93.33 | Professional | None | $47.86 | $56.23 | $93.33 |
CareSource Setting Facility Modifier None Typical Low $74.13 Median $74.13 Typical High $97.72 | Facility | None | $74.13 | $74.13 | $97.72 |
Cigna Setting Facility Modifier None Typical Low $79.43 Median $141.25 Typical High $1,479.11 | Facility | None | $79.43 | $141.25 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $57.54 Median $109.65 Typical High $204.17 | Professional | None | $57.54 | $109.65 | $204.17 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $79.43 Median $141.25 Typical High $1,479.11 | Facility | None | $79.43 | $141.25 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $57.54 Median $109.65 Typical High $204.17 | Professional | None | $57.54 | $109.65 | $204.17 |
Molina Setting Professional Modifier None Typical Low $93.33 Median $123.03 Typical High $165.96 | Professional | None | $93.33 | $123.03 | $165.96 |
SummaCare Setting Facility Modifier None Typical Low $42.66 Median $44.67 Typical High $51.29 | Facility | None | $42.66 | $44.67 | $51.29 |
SummaCare Setting Professional Modifier None Typical Low $54.95 Median $109.65 Typical High $144.54 | Professional | None | $54.95 | $109.65 | $144.54 |
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 $53.70 Median $95.50 Typical High $194.98 | Professional | None | $53.70 | $95.50 | $194.98 |
5 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 $29.51 Median $52.48 Typical High $54.95 | Professional | 52 · Reduced service | $29.51 | $52.48 | $54.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.75 Median $21.38 Typical High $21.88 | Professional | 53 · Discontinued | $11.75 | $21.38 | $21.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $43.65 Median $79.43 Typical High $83.18 | Professional | 54 · Surgery only | $43.65 | $79.43 | $83.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.71 Median $15.85 Typical High $16.60 | Professional | 55 · Aftercare only | $8.71 | $15.85 | $16.60 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.89 Median $10.47 Typical High $10.96 | Professional | 56 · Pre-op care only | $5.89 | $10.47 | $10.96 |
Where Ohio sits
The same service costs 3.9 times more in Wisconsin 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· 41st of 51
$105
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.