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 $660.69 Median $4,365.16 Typical High $12,589.25 | Facility | None | $660.69 | $4,365.16 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $281.84 Typical High $3,467.37 | Professional | None | $194.98 | $281.84 | $3,467.37 |
Anthem BCBS Setting Facility Modifier None Typical Low $416.87 Median $912.01 Typical High $3,715.35 | Facility | None | $416.87 | $912.01 | $3,715.35 |
Anthem BCBS Setting Professional Modifier None Typical Low $177.83 Median $245.47 Typical High $407.38 | Professional | None | $177.83 | $245.47 | $407.38 |
CareSource Setting Facility Modifier None Typical Low $245.47 Median $263.03 Typical High $346.74 | Facility | None | $245.47 | $263.03 | $346.74 |
Cigna Setting Facility Modifier None Typical Low $288.40 Median $446.68 Typical High $1,995.26 | Facility | None | $288.40 | $446.68 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $302.00 Typical High $549.54 | Professional | None | $208.93 | $302.00 | $549.54 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $288.40 Median $446.68 Typical High $1,995.26 | Facility | None | $288.40 | $446.68 | $1,995.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $208.93 Median $302.00 Typical High $562.34 | Professional | None | $208.93 | $302.00 | $562.34 |
Molina Setting Professional Modifier None Typical Low $38.02 Median $295.12 Typical High $436.52 | Professional | None | $38.02 | $295.12 | $436.52 |
SummaCare Setting Facility Modifier None Typical Low $151.36 Median $158.49 Typical High $181.97 | Facility | None | $151.36 | $158.49 | $181.97 |
SummaCare Setting Professional Modifier None Typical Low $190.55 Median $302.00 Typical High $398.11 | Professional | None | $190.55 | $302.00 | $398.11 |
United Setting Facility Modifier None Typical Low $97.72 Median $275.42 Typical High $2,398.83 | Facility | None | $97.72 | $275.42 | $2,398.83 |
United Setting Professional Modifier None Typical Low $208.93 Median $309.03 Typical High $549.54 | Professional | None | $208.93 | $309.03 | $549.54 |
6 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 $97.72 Median $141.25 Typical High $144.54 | Professional | 52 · Reduced service | $97.72 | $141.25 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $56.23 Typical High $57.54 | Professional | 53 · Discontinued | $38.90 | $56.23 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $208.93 Typical High $218.78 | Professional | 54 · Surgery only | $144.54 | $208.93 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $41.69 Typical High $43.65 | Professional | 55 · Aftercare only | $28.84 | $41.69 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $28.18 Typical High $28.84 | Professional | 56 · Pre-op care only | $19.50 | $28.18 | $28.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $194.98 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $134.90 | $194.98 | $204.17 |
Where Ohio sits
The same service costs 3.7 times more in Wisconsin than in Utah. 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· 46th of 51
$282
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.