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 $436.52 Median $1,995.26 Typical High $10,964.78 | Facility | None | $436.52 | $1,995.26 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $158.49 Median $245.47 Typical High $2,089.30 | Professional | None | $158.49 | $245.47 | $2,089.30 |
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 $123.03 Median $204.17 Typical High $331.13 | Professional | None | $123.03 | $204.17 | $331.13 |
CareSource Setting Facility Modifier None Typical Low $190.55 Median $194.98 Typical High $251.19 | Facility | None | $190.55 | $194.98 | $251.19 |
Cigna Setting Facility Modifier None Typical Low $199.53 Median $323.59 Typical High $1,479.11 | Facility | None | $199.53 | $323.59 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $162.18 Median $251.19 Typical High $457.09 | Professional | None | $162.18 | $251.19 | $457.09 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $199.53 Median $323.59 Typical High $1,479.11 | Facility | None | $199.53 | $323.59 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $162.18 Median $251.19 Typical High $478.63 | Professional | None | $162.18 | $251.19 | $478.63 |
Molina Setting Professional Modifier None Typical Low $36.31 Median $229.09 Typical High $338.84 | Professional | None | $36.31 | $229.09 | $338.84 |
SummaCare Setting Facility Modifier None Typical Low $104.71 Median $109.65 Typical High $125.89 | Facility | None | $104.71 | $109.65 | $125.89 |
SummaCare Setting Professional Modifier None Typical Low $151.36 Median $245.47 Typical High $323.59 | Professional | None | $151.36 | $245.47 | $323.59 |
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 $162.18 Median $257.04 Typical High $478.63 | Professional | None | $162.18 | $257.04 | $478.63 |
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 $79.43 Median $123.03 Typical High $125.89 | Professional | 52 · Reduced service | $79.43 | $123.03 | $125.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $31.62 Median $48.98 Typical High $51.29 | Professional | 53 · Discontinued | $31.62 | $48.98 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $120.23 Median $186.21 Typical High $190.55 | Professional | 54 · Surgery only | $120.23 | $186.21 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $37.15 Typical High $38.02 | Professional | 55 · Aftercare only | $23.99 | $37.15 | $38.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.85 Median $24.55 Typical High $25.70 | Professional | 56 · Pre-op care only | $15.85 | $24.55 | $25.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $112.20 Median $173.78 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $112.20 | $173.78 | $177.83 |
Where Ohio sits
The same service costs 4.3 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· 48th of 51
$234
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.