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 $912.01 Median $4,365.16 Typical High $12,589.25 | Facility | None | $912.01 | $4,365.16 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $134.90 Median $575.44 Typical High $1,348.96 | Professional | None | $134.90 | $575.44 | $1,348.96 |
Anthem BCBS Setting Facility Modifier None Typical Low $16,595.87 Median $16,595.87 Typical High $18,620.87 | Facility | None | $16,595.87 | $16,595.87 | $18,620.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $125.89 Median $263.03 Typical High $831.76 | Professional | None | $125.89 | $263.03 | $831.76 |
Cigna Setting Facility Modifier None Typical Low $21,379.62 Median $21,379.62 Typical High $21,379.62 | Facility | None | $21,379.62 | $21,379.62 | $21,379.62 |
Cigna Setting Professional Modifier None Typical Low $123.03 Median $389.05 Typical High $831.76 | Professional | None | $123.03 | $389.05 | $831.76 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $21,379.62 Median $21,379.62 Typical High $21,379.62 | Facility | None | $21,379.62 | $21,379.62 | $21,379.62 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $123.03 Median $389.05 Typical High $812.83 | Professional | None | $123.03 | $389.05 | $812.83 |
Molina Setting Professional Modifier None Typical Low $457.09 Median $630.96 Typical High $870.96 | Professional | None | $457.09 | $630.96 | $870.96 |
SummaCare Setting Professional Modifier None Typical Low $112.20 Median $537.03 Typical High $691.83 | Professional | None | $112.20 | $537.03 | $691.83 |
United Setting Facility Modifier None Typical Low $478.63 Median $1,445.44 Typical High $3,715.35 | Facility | None | $478.63 | $1,445.44 | $3,715.35 |
United Setting Professional Modifier None Typical Low $128.82 Median $467.74 Typical High $912.01 | Professional | None | $128.82 | $467.74 | $912.01 |
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 $67.61 Median $288.40 Typical High $380.19 | Professional | 52 · Reduced service | $67.61 | $288.40 | $380.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $114.82 Typical High $151.36 | Professional | 53 · Discontinued | $26.92 | $114.82 | $151.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $426.58 Typical High $562.34 | Professional | 54 · Surgery only | $100.00 | $426.58 | $562.34 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $85.11 Typical High $114.82 | Professional | 55 · Aftercare only | $19.95 | $85.11 | $114.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.49 Median $57.54 Typical High $75.86 | Professional | 56 · Pre-op care only | $13.49 | $57.54 | $75.86 |
Where Ohio sits
The same service costs 4.0 times more in Wisconsin than in Maryland. 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· 27th of 51
$490
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.