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 $363.08 Median $4,265.80 Typical High $12,022.64 | Facility | None | $363.08 | $4,265.80 | $12,022.64 |
Aetna Setting Professional Modifier None Typical Low $186.21 Median $186.21 Typical High $9,120.11 | Professional | None | $186.21 | $186.21 | $9,120.11 |
Anthem BCBS Setting Facility Modifier None Typical Low $758.58 Median $2,187.76 Typical High $7,079.46 | Facility | None | $758.58 | $2,187.76 | $7,079.46 |
Anthem BCBS Setting Professional Modifier None Typical Low $199.53 Median $302.00 Typical High $436.52 | Professional | None | $199.53 | $302.00 | $436.52 |
CareSource Setting Facility Modifier None Typical Low $229.09 Median $2,454.71 Typical High $3,162.28 | Facility | None | $229.09 | $2,454.71 | $3,162.28 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $2,570.40 Typical High $6,025.60 | Facility | None | $549.54 | $2,570.40 | $6,025.60 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $208.93 Typical High $398.11 | Professional | None | $173.78 | $208.93 | $398.11 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $549.54 Median $2,570.40 Typical High $6,025.60 | Facility | None | $549.54 | $2,570.40 | $6,025.60 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $173.78 Median $208.93 Typical High $407.38 | Professional | None | $173.78 | $208.93 | $407.38 |
Molina Setting Professional Modifier None Typical Low $125.89 Median $165.96 Typical High $223.87 | Professional | None | $125.89 | $165.96 | $223.87 |
SummaCare Setting Facility Modifier None Typical Low $2,454.71 Median $2,570.40 Typical High $2,951.21 | Facility | None | $2,454.71 | $2,570.40 | $2,951.21 |
SummaCare Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $257.04 | Professional | None | $162.18 | $162.18 | $257.04 |
United Setting Facility Modifier None Typical Low $851.14 Median $2,630.27 Typical High $8,912.51 | Facility | None | $851.14 | $2,630.27 | $8,912.51 |
United Setting Professional Modifier None Typical Low $186.21 Median $229.09 Typical High $457.09 | Professional | None | $186.21 | $229.09 | $457.09 |
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 $91.20 Median $91.20 Typical High $363.08 | Professional | 52 · Reduced service | $91.20 | $91.20 | $363.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $37.15 Typical High $144.54 | Professional | 53 · Discontinued | $37.15 | $37.15 | $144.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $138.04 Typical High $549.54 | Professional | 54 · Surgery only | $138.04 | $138.04 | $549.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $27.54 Typical High $109.65 | Professional | 55 · Aftercare only | $27.54 | $27.54 | $109.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $18.62 Typical High $72.44 | Professional | 56 · Pre-op care only | $18.62 | $18.62 | $72.44 |
Where Ohio sits
The same service costs 10.2 times more in Oklahoma 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· 37th of 51
$257
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.