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 $257.04 Median $1,995.26 Typical High $10,964.78 | Facility | None | $257.04 | $1,995.26 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $389.05 Typical High $2,630.27 | Professional | None | $89.13 | $389.05 | $2,630.27 |
Anthem BCBS Setting Facility Modifier None Typical Low $371.54 Median $794.33 Typical High $3,311.31 | Facility | None | $371.54 | $794.33 | $3,311.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $79.43 Median $275.42 Typical High $501.19 | Professional | None | $79.43 | $275.42 | $501.19 |
CareSource Setting Facility Modifier None Typical Low $100.00 Median $323.59 Typical High $416.87 | Facility | None | $100.00 | $323.59 | $416.87 |
Cigna Setting Facility Modifier None Typical Low $323.59 Median $512.86 Typical High $2,398.83 | Facility | None | $323.59 | $512.86 | $2,398.83 |
Cigna Setting Professional Modifier None Typical Low $91.20 Median $263.03 Typical High $575.44 | Professional | None | $91.20 | $263.03 | $575.44 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $323.59 Median $501.19 Typical High $2,398.83 | Facility | None | $323.59 | $501.19 | $2,398.83 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $91.20 Median $245.47 Typical High $575.44 | Professional | None | $91.20 | $245.47 | $575.44 |
Molina Setting Professional Modifier None Typical Low $331.13 Median $407.38 Typical High $524.81 | Professional | None | $331.13 | $407.38 | $524.81 |
SummaCare Setting Facility Modifier None Typical Low $177.83 Median $186.21 Typical High $213.80 | Facility | None | $177.83 | $186.21 | $213.80 |
SummaCare Setting Professional Modifier None Typical Low $75.86 Median $354.81 Typical High $537.03 | Professional | None | $75.86 | $354.81 | $537.03 |
United Setting Facility Modifier None Typical Low $363.08 Median $691.83 Typical High $3,311.31 | Facility | None | $363.08 | $691.83 | $3,311.31 |
United Setting Professional Modifier None Typical Low $100.00 Median $371.54 Typical High $758.58 | Professional | None | $100.00 | $371.54 | $758.58 |
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 $44.67 Median $194.98 Typical High $251.19 | Professional | 52 · Reduced service | $44.67 | $194.98 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.78 Median $77.62 Typical High $100.00 | Professional | 53 · Discontinued | $17.78 | $77.62 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $288.40 Typical High $371.54 | Professional | 54 · Surgery only | $67.61 | $288.40 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $58.88 Typical High $74.13 | Professional | 55 · Aftercare only | $13.49 | $58.88 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $38.90 Typical High $50.12 | Professional | 56 · Pre-op care only | $8.91 | $38.90 | $50.12 |
Where Ohio sits
The same service costs 7.8 times more in Oklahoma 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· 42nd of 51
$389
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.