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 $1,000.00 Median $4,365.16 Typical High $10,964.78 | Facility | None | $1,000.00 | $4,365.16 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $363.08 Median $1,862.09 Typical High $4,786.30 | Professional | None | $363.08 | $1,862.09 | $4,786.30 |
Ambetter Setting Professional Modifier None Typical Low $234.42 Median $234.42 Typical High $234.42 | Professional | None | $234.42 | $234.42 | $234.42 |
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 $316.23 Median $575.44 Typical High $2,818.38 | Professional | None | $316.23 | $575.44 | $2,818.38 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $478.63 Typical High $21,379.62 | Facility | None | $478.63 | $478.63 | $21,379.62 |
Cigna Setting Professional Modifier None Typical Low $323.59 Median $977.24 Typical High $3,019.95 | Professional | None | $323.59 | $977.24 | $3,019.95 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $10,000.00 Median $12,022.64 Typical High $21,379.62 | Facility | None | $10,000.00 | $12,022.64 | $21,379.62 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $323.59 Median $1,000.00 Typical High $2,951.21 | Professional | None | $323.59 | $1,000.00 | $2,951.21 |
Molina Setting Professional Modifier None Typical Low $1,584.89 Median $2,290.87 Typical High $3,235.94 | Professional | None | $1,584.89 | $2,290.87 | $3,235.94 |
SummaCare Setting Professional Modifier None Typical Low $316.23 Median $1,905.46 Typical High $2,511.89 | Professional | None | $316.23 | $1,905.46 | $2,511.89 |
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 $346.74 Median $1,513.56 Typical High $3,311.31 | Professional | None | $346.74 | $1,513.56 | $3,311.31 |
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 $181.97 Median $870.96 Typical High $1,047.13 | Professional | 52 · Reduced service | $181.97 | $870.96 | $1,047.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $72.44 Median $354.81 Typical High $416.87 | Professional | 53 · Discontinued | $72.44 | $354.81 | $416.87 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $275.42 Median $1,318.26 Typical High $1,548.82 | Professional | 54 · Surgery only | $275.42 | $1,318.26 | $1,548.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $54.95 Median $263.03 Typical High $309.03 | Professional | 55 · Aftercare only | $54.95 | $263.03 | $309.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $36.31 Median $173.78 Typical High $208.93 | Professional | 56 · Pre-op care only | $36.31 | $173.78 | $208.93 |
Where Ohio sits
The same service costs 5.5 times more in Washington 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· 24th of 51
$1,698
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.