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 $3,548.13 Typical High $10,715.19 | Facility | None | $707.95 | $3,548.13 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $281.84 Median $1,318.26 Typical High $3,630.78 | Professional | None | $281.84 | $1,318.26 | $3,630.78 |
Ambetter Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | None | $173.78 | $173.78 | $173.78 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,659.59 Median $3,311.31 Typical High $15,848.93 | Facility | None | $1,659.59 | $3,311.31 | $15,848.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $269.15 Median $1,023.29 Typical High $1,949.84 | Professional | None | $269.15 | $1,023.29 | $1,949.84 |
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 $257.04 Median $776.25 Typical High $2,041.74 | Professional | None | $257.04 | $776.25 | $2,041.74 |
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 $257.04 Median $776.25 Typical High $1,949.84 | Professional | None | $257.04 | $776.25 | $1,949.84 |
Molina Setting Professional Modifier None Typical Low $1,047.13 Median $1,445.44 Typical High $1,995.26 | Professional | None | $1,047.13 | $1,445.44 | $1,995.26 |
SummaCare Setting Professional Modifier None Typical Low $234.42 Median $1,202.26 Typical High $1,548.82 | Professional | None | $234.42 | $1,202.26 | $1,548.82 |
United Setting Facility Modifier None Typical Low $3,548.13 Median $6,606.93 Typical High $9,772.37 | Facility | None | $3,548.13 | $6,606.93 | $9,772.37 |
United Setting Professional Modifier None Typical Low $275.42 Median $1,258.93 Typical High $2,454.71 | Professional | None | $275.42 | $1,258.93 | $2,454.71 |
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 $141.25 Median $660.69 Typical High $776.25 | Professional | 52 · Reduced service | $141.25 | $660.69 | $776.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $263.03 Typical High $309.03 | Professional | 53 · Discontinued | $56.23 | $263.03 | $309.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $1,000.00 Typical High $1,174.90 | Professional | 54 · Surgery only | $208.93 | $1,000.00 | $1,174.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $199.53 Typical High $234.42 | Professional | 55 · Aftercare only | $41.69 | $199.53 | $234.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $131.83 Typical High $154.88 | Professional | 56 · Pre-op care only | $28.18 | $131.83 | $154.88 |
Where Ohio sits
The same service costs 4.7 times more in Wisconsin than in Nebraska. 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· 28th of 51
$1,259
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.