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 $52.48 Median $338.84 Typical High $10,715.19 | Facility | None | $52.48 | $338.84 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $28.84 Median $93.33 Typical High $1,202.26 | Professional | None | $28.84 | $93.33 | $1,202.26 |
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 $26.92 Median $56.23 Typical High $117.49 | Professional | None | $26.92 | $56.23 | $117.49 |
CareSource Setting Facility Modifier None Typical Low $36.31 Median $83.18 Typical High $107.15 | Facility | None | $36.31 | $83.18 | $107.15 |
Cigna Setting Facility Modifier None Typical Low $58.88 Median $97.72 Typical High $208.93 | Facility | None | $58.88 | $97.72 | $208.93 |
Cigna Setting Professional Modifier None Typical Low $30.20 Median $95.50 Typical High $199.53 | Professional | None | $30.20 | $95.50 | $199.53 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $58.88 Median $97.72 Typical High $208.93 | Facility | None | $58.88 | $97.72 | $208.93 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $30.20 Median $95.50 Typical High $204.17 | Professional | None | $30.20 | $95.50 | $204.17 |
Molina Setting Professional Modifier None Typical Low $91.20 Median $123.03 Typical High $165.96 | Professional | None | $91.20 | $123.03 | $165.96 |
SummaCare Setting Facility Modifier None Typical Low $45.71 Median $48.98 Typical High $54.95 | Facility | None | $45.71 | $48.98 | $54.95 |
SummaCare Setting Professional Modifier None Typical Low $28.84 Median $97.72 Typical High $128.82 | Professional | None | $28.84 | $97.72 | $128.82 |
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 $30.90 Median $81.28 Typical High $173.78 | Professional | None | $30.90 | $81.28 | $173.78 |
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 $14.45 Median $46.77 Typical High $48.98 | Professional | 52 · Reduced service | $14.45 | $46.77 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.75 Median $18.62 Typical High $19.50 | Professional | 53 · Discontinued | $5.75 | $18.62 | $19.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $21.38 Median $70.79 Typical High $74.13 | Professional | 54 · Surgery only | $21.38 | $70.79 | $74.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.27 Median $14.13 Typical High $14.79 | Professional | 55 · Aftercare only | $4.27 | $14.13 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.88 Median $9.33 Typical High $9.77 | Professional | 56 · Pre-op care only | $2.88 | $9.33 | $9.77 |
Where Ohio sits
The same service costs 5.4 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· 39th of 51
$93.33
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.