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 $707.95 Median $4,365.16 Typical High $12,589.25 | Facility | None | $707.95 | $4,365.16 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $263.03 Typical High $3,019.95 | Professional | None | $131.83 | $263.03 | $3,019.95 |
Anthem BCBS Setting Facility Modifier None Typical Low $407.38 Median $831.76 Typical High $3,715.35 | Facility | None | $407.38 | $831.76 | $3,715.35 |
Anthem BCBS Setting Professional Modifier None Typical Low $138.04 Median $213.80 Typical High $354.81 | Professional | None | $138.04 | $213.80 | $354.81 |
CareSource Setting Facility Modifier None Typical Low $162.18 Median $199.53 Typical High $263.03 | Facility | None | $162.18 | $199.53 | $263.03 |
Cigna Setting Facility Modifier None Typical Low $204.17 Median $371.54 Typical High $1,995.26 | Facility | None | $204.17 | $371.54 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $269.15 Typical High $436.52 | Professional | None | $134.90 | $269.15 | $436.52 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $208.93 Median $371.54 Typical High $1,995.26 | Facility | None | $208.93 | $371.54 | $1,995.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $134.90 Median $269.15 Typical High $446.68 | Professional | None | $134.90 | $269.15 | $446.68 |
Molina Setting Professional Modifier None Typical Low $239.88 Median $323.59 Typical High $436.52 | Professional | None | $239.88 | $323.59 | $436.52 |
SummaCare Setting Facility Modifier None Typical Low $109.65 Median $114.82 Typical High $131.83 | Facility | None | $109.65 | $114.82 | $131.83 |
SummaCare Setting Professional Modifier None Typical Low $123.03 Median $275.42 Typical High $346.74 | Professional | None | $123.03 | $275.42 | $346.74 |
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 $131.83 Median $229.09 Typical High $478.63 | Professional | None | $131.83 | $229.09 | $478.63 |
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 $66.07 Median $131.83 Typical High $134.90 | Professional | 52 · Reduced service | $66.07 | $131.83 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $52.48 Typical High $54.95 | Professional | 53 · Discontinued | $26.30 | $52.48 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $194.98 Typical High $204.17 | Professional | 54 · Surgery only | $97.72 | $194.98 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $39.81 Typical High $40.74 | Professional | 55 · Aftercare only | $19.50 | $39.81 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $26.30 Typical High $27.54 | Professional | 56 · Pre-op care only | $13.18 | $26.30 | $27.54 |
Where Ohio sits
The same service costs 3.1 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· 40th of 51
$257
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.