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 $1,000.00 Median $4,365.16 Typical High $12,589.25 | Facility | None | $1,000.00 | $4,365.16 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $275.42 Typical High $3,548.13 | Professional | None | $194.98 | $275.42 | $3,548.13 |
Anthem BCBS Setting Facility Modifier None Typical Low $389.05 Median $954.99 Typical High $3,715.35 | Facility | None | $389.05 | $954.99 | $3,715.35 |
Anthem BCBS Setting Professional Modifier None Typical Low $186.21 Median $251.19 Typical High $407.38 | Professional | None | $186.21 | $251.19 | $407.38 |
CareSource Setting Facility Modifier None Typical Low $173.78 Median $229.09 Typical High $245.47 | Facility | None | $173.78 | $229.09 | $245.47 |
Cigna Setting Facility Modifier None Typical Low $186.21 Median $338.84 Typical High $1,995.26 | Facility | None | $186.21 | $338.84 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $295.12 Typical High $575.44 | Professional | None | $208.93 | $295.12 | $575.44 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $186.21 Median $331.13 Typical High $1,995.26 | Facility | None | $186.21 | $331.13 | $1,995.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $208.93 Median $295.12 Typical High $562.34 | Professional | None | $208.93 | $295.12 | $562.34 |
Molina Setting Professional Modifier None Typical Low $36.31 Median $275.42 Typical High $436.52 | Professional | None | $36.31 | $275.42 | $436.52 |
SummaCare Setting Facility Modifier None Typical Low $97.72 Median $104.71 Typical High $117.49 | Facility | None | $97.72 | $104.71 | $117.49 |
SummaCare Setting Professional Modifier None Typical Low $186.21 Median $288.40 Typical High $380.19 | Professional | None | $186.21 | $288.40 | $380.19 |
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 $575.44 | Professional | None | $208.93 | $309.03 | $575.44 |
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 $138.04 Typical High $141.25 | Professional | 52 · Reduced service | $97.72 | $138.04 | $141.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $54.95 Typical High $56.23 | Professional | 53 · Discontinued | $38.90 | $54.95 | $56.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $204.17 Typical High $208.93 | Professional | 54 · Surgery only | $144.54 | $204.17 | $208.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $40.74 Typical High $41.69 | Professional | 55 · Aftercare only | $28.84 | $40.74 | $41.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $27.54 Typical High $28.18 | Professional | 56 · Pre-op care only | $19.50 | $27.54 | $28.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $190.55 Typical High $194.98 | Professional | 78 · Unplanned return to OR | $134.90 | $190.55 | $194.98 |
Where Ohio sits
The same service costs 3.7 times more in Wisconsin than in Texas. 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· 43rd of 51
$288
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.