How much rates vary
Facilitymedian $794 · 10th to 90th $186 to $4,786Professionalmedian $191 · 10th to 90th $117 to $331
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 $331.13 Median $1,995.26 Typical High $10,964.78 | Facility | None | $331.13 | $1,995.26 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $208.93 Typical High $1,905.46 | Professional | None | $120.23 | $208.93 | $1,905.46 |
Ambetter Setting Professional Modifier None Typical Low $234.42 Median $234.42 Typical High $234.42 | Professional | None | $234.42 | $234.42 | $234.42 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $1,174.90 Typical High $4,570.88 | Facility | None | $524.81 | $1,174.90 | $4,570.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $100.00 Median $144.54 Typical High $263.03 | Professional | None | $100.00 | $144.54 | $263.03 |
CareSource Setting Facility Modifier None Typical Low $147.91 Median $154.88 Typical High $199.53 | Facility | None | $147.91 | $154.88 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $158.49 Median $269.15 Typical High $2,398.83 | Facility | None | $158.49 | $269.15 | $2,398.83 |
Cigna Setting Professional Modifier None Typical Low $123.03 Median $204.17 Typical High $371.54 | Professional | None | $123.03 | $204.17 | $371.54 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $158.49 Median $251.19 Typical High $2,398.83 | Facility | None | $158.49 | $251.19 | $2,398.83 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $123.03 Median $204.17 Typical High $380.19 | Professional | None | $123.03 | $204.17 | $380.19 |
Molina Setting Professional Modifier None Typical Low $158.49 Median $229.09 Typical High $309.03 | Professional | None | $158.49 | $229.09 | $309.03 |
SummaCare Setting Facility Modifier None Typical Low $85.11 Median $89.13 Typical High $102.33 | Facility | None | $85.11 | $89.13 | $102.33 |
SummaCare Setting Professional Modifier None Typical Low $114.82 Median $213.80 Typical High $275.42 | Professional | None | $114.82 | $213.80 | $275.42 |
United Setting Facility Modifier None Typical Low $501.19 Median $977.24 Typical High $4,786.30 | Facility | None | $501.19 | $977.24 | $4,786.30 |
United Setting Professional Modifier None Typical Low $123.03 Median $204.17 Typical High $371.54 | Professional | None | $123.03 | $204.17 | $371.54 |
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 $60.26 Median $102.33 Typical High $107.15 | Professional | 52 · Reduced service | $60.26 | $102.33 | $107.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $41.69 Typical High $42.66 | Professional | 53 · Discontinued | $23.99 | $41.69 | $42.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $154.88 Typical High $162.18 | Professional | 54 · Surgery only | $89.13 | $154.88 | $162.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.78 Median $30.90 Typical High $32.36 | Professional | 55 · Aftercare only | $17.78 | $30.90 | $32.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $20.89 Typical High $21.38 | Professional | 56 · Pre-op care only | $12.02 | $20.89 | $21.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $83.18 Median $144.54 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $83.18 | $144.54 | $151.36 |
Where Ohio sits
The same service costs 3.8 times more in Wisconsin 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· 46th of 51
$204
WI $631KY $166
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.