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 $575.44 Median $5,754.40 Typical High $12,022.64 | Facility | None | $575.44 | $5,754.40 | $12,022.64 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $194.98 Typical High $7,943.28 | Professional | None | $194.98 | $194.98 | $7,943.28 |
Anthem BCBS Setting Facility Modifier None Typical Low $912.01 Median $2,344.23 Typical High $9,772.37 | Facility | None | $912.01 | $2,344.23 | $9,772.37 |
Anthem BCBS Setting Professional Modifier None Typical Low $181.97 Median $213.80 Typical High $346.74 | Professional | None | $181.97 | $213.80 | $346.74 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $3,715.35 Typical High $6,456.54 | Facility | None | $549.54 | $3,715.35 | $6,456.54 |
Cigna Setting Professional Modifier None Typical Low $194.98 Median $229.09 Typical High $524.81 | Professional | None | $194.98 | $229.09 | $524.81 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $549.54 Median $3,715.35 Typical High $6,456.54 | Facility | None | $549.54 | $3,715.35 | $6,456.54 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $194.98 Median $218.78 Typical High $524.81 | Professional | None | $194.98 | $218.78 | $524.81 |
Molina Setting Professional Modifier None Typical Low $162.18 Median $208.93 Typical High $275.42 | Professional | None | $162.18 | $208.93 | $275.42 |
SummaCare Setting Facility Modifier None Typical Low $1,819.70 Median $1,905.46 Typical High $2,137.96 | Facility | None | $1,819.70 | $1,905.46 | $2,137.96 |
SummaCare Setting Professional Modifier None Typical Low $186.21 Median $186.21 Typical High $331.13 | Professional | None | $186.21 | $186.21 | $331.13 |
United Setting Facility Modifier None Typical Low $707.95 Median $1,905.46 Typical High $7,413.10 | Facility | None | $707.95 | $1,905.46 | $7,413.10 |
United Setting Professional Modifier None Typical Low $199.53 Median $263.03 Typical High $489.78 | Professional | None | $199.53 | $263.03 | $489.78 |
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 $97.72 Median $97.72 Typical High $389.05 | Professional | 52 · Reduced service | $97.72 | $97.72 | $389.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $38.90 Typical High $154.88 | Professional | 53 · Discontinued | $38.90 | $38.90 | $154.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $147.91 Typical High $588.84 | Professional | 54 · Surgery only | $147.91 | $147.91 | $588.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $29.51 Typical High $117.49 | Professional | 55 · Aftercare only | $29.51 | $29.51 | $117.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $19.50 Typical High $77.62 | Professional | 56 · Pre-op care only | $19.50 | $19.50 | $77.62 |
Where Ohio sits
The same service costs 6.9 times more in Tennessee than in New York. 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· 44th of 51
$240
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.