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 $309.03 Median $501.19 Typical High $12,589.25 | Facility | None | $309.03 | $501.19 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $112.20 Median $181.97 Typical High $602.56 | Professional | None | $112.20 | $181.97 | $602.56 |
Anthem BCBS Setting Facility Modifier None Typical Low $380.19 Median $831.76 Typical High $3,311.31 | Facility | None | $380.19 | $831.76 | $3,311.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $97.72 Median $151.36 Typical High $269.15 | Professional | None | $97.72 | $151.36 | $269.15 |
CareSource Setting Facility Modifier None Typical Low $144.54 Median $537.03 Typical High $812.83 | Facility | None | $144.54 | $537.03 | $812.83 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $794.33 | Facility | None | $50.12 | $66.07 | $794.33 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $194.98 Typical High $346.74 | Professional | None | $117.49 | $194.98 | $346.74 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $794.33 | Facility | None | $50.12 | $66.07 | $794.33 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $117.49 Median $194.98 Typical High $354.81 | Professional | None | $117.49 | $194.98 | $354.81 |
Molina Setting Professional Modifier None Typical Low $165.96 Median $229.09 Typical High $316.23 | Professional | None | $165.96 | $229.09 | $316.23 |
SummaCare Setting Professional Modifier None Typical Low $114.82 Median $204.17 Typical High $269.15 | Professional | None | $114.82 | $204.17 | $269.15 |
United Setting Facility Modifier None Typical Low $501.19 Median $977.24 Typical High $4,677.35 | Facility | None | $501.19 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $117.49 Median $194.98 Typical High $354.81 | Professional | None | $117.49 | $194.98 | $354.81 |
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 $54.95 Median $91.20 Typical High $93.33 | Professional | 52 · Reduced service | $54.95 | $91.20 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.39 Median $36.31 Typical High $37.15 | Professional | 53 · Discontinued | $22.39 | $36.31 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $134.90 Typical High $141.25 | Professional | 54 · Surgery only | $83.18 | $134.90 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $26.92 Typical High $28.18 | Professional | 55 · Aftercare only | $16.60 | $26.92 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.22 Median $18.20 Typical High $18.62 | Professional | 56 · Pre-op care only | $11.22 | $18.20 | $18.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $77.62 Median $125.89 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $77.62 | $125.89 | $131.83 |
Where Ohio sits
The same service costs 3.8 times more in Wisconsin than in Hawaii. 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· 38th of 51
$195
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.