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 $213.80 Median $10,232.93 Typical High $13,803.84 | Facility | None | $213.80 | $10,232.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $141.25 Median $213.80 Typical High $724.44 | Professional | None | $141.25 | $213.80 | $724.44 |
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 $128.82 Median $186.21 Typical High $309.03 | Professional | None | $128.82 | $186.21 | $309.03 |
CareSource Setting Facility Modifier None Typical Low $120.23 Median $154.88 Typical High $177.83 | Facility | None | $120.23 | $154.88 | $177.83 |
Cigna Setting Facility Modifier None Typical Low $58.88 Median $138.04 Typical High $275.42 | Facility | None | $58.88 | $138.04 | $275.42 |
Cigna Setting Professional Modifier None Typical Low $165.96 Median $263.03 Typical High $416.87 | Professional | None | $165.96 | $263.03 | $416.87 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $58.88 Median $138.04 Typical High $275.42 | Facility | None | $58.88 | $138.04 | $275.42 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $165.96 Median $269.15 Typical High $416.87 | Professional | None | $165.96 | $269.15 | $416.87 |
Molina Setting Professional Modifier None Typical Low $169.82 Median $245.47 Typical High $346.74 | Professional | None | $169.82 | $245.47 | $346.74 |
SummaCare Setting Facility Modifier None Typical Low $66.07 Median $69.18 Typical High $79.43 | Facility | None | $66.07 | $69.18 | $79.43 |
SummaCare Setting Professional Modifier None Typical Low $138.04 Median $229.09 Typical High $295.12 | Professional | None | $138.04 | $229.09 | $295.12 |
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 $158.49 Median $251.19 Typical High $478.63 | Professional | None | $158.49 | $251.19 | $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 $70.79 Median $107.15 Typical High $112.20 | Professional | 52 · Reduced service | $70.79 | $107.15 | $112.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $42.66 Typical High $45.71 | Professional | 53 · Discontinued | $28.18 | $42.66 | $45.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $162.18 Typical High $169.82 | Professional | 54 · Surgery only | $107.15 | $162.18 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $32.36 Typical High $33.88 | Professional | 55 · Aftercare only | $21.38 | $32.36 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $21.38 Typical High $22.91 | Professional | 56 · Pre-op care only | $14.13 | $21.38 | $22.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $151.36 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $100.00 | $151.36 | $158.49 |
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· 41st of 51
$224
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.