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 $302.00 Median $10,232.93 Typical High $13,803.84 | Facility | None | $302.00 | $10,232.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $10,232.93 | Professional | None | $199.53 | $199.53 | $10,232.93 |
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 $218.78 Median $302.00 Typical High $436.52 | Professional | None | $218.78 | $302.00 | $436.52 |
CareSource Setting Facility Modifier None Typical Low $223.87 Median $223.87 Typical High $223.87 | Facility | None | $223.87 | $223.87 | $223.87 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,691.53 | Facility | None | $426.58 | $588.84 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $181.97 Median $223.87 Typical High $457.09 | Professional | None | $181.97 | $223.87 | $457.09 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,691.53 | Facility | None | $426.58 | $588.84 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $181.97 Median $223.87 Typical High $457.09 | Professional | None | $181.97 | $223.87 | $457.09 |
Molina Setting Professional Modifier None Typical Low $154.88 Median $194.98 Typical High $245.47 | Professional | None | $154.88 | $194.98 | $245.47 |
SummaCare Setting Professional Modifier None Typical Low $177.83 Median $194.98 Typical High $331.13 | Professional | None | $177.83 | $194.98 | $331.13 |
United Setting Facility Modifier None Typical Low $371.54 Median $977.24 Typical High $4,677.35 | Facility | None | $371.54 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $194.98 Median $281.84 Typical High $549.54 | Professional | None | $194.98 | $281.84 | $549.54 |
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 $100.00 Median $100.00 Typical High $371.54 | Professional | 52 · Reduced service | $100.00 | $100.00 | $371.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $39.81 Typical High $147.91 | Professional | 53 · Discontinued | $39.81 | $39.81 | $147.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $151.36 Median $151.36 Typical High $549.54 | Professional | 54 · Surgery only | $151.36 | $151.36 | $549.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.20 Median $30.20 Typical High $109.65 | Professional | 55 · Aftercare only | $30.20 | $30.20 | $109.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $19.95 Typical High $74.13 | Professional | 56 · Pre-op care only | $19.95 | $19.95 | $74.13 |
Where Ohio sits
The same service costs 4.3 times more in Wisconsin 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· 29th of 51
$302
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.