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 $239.88 Median $1,995.26 Typical High $10,964.78 | Facility | None | $239.88 | $1,995.26 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $87.10 Median $316.23 Typical High $457.09 | Professional | None | $87.10 | $316.23 | $457.09 |
Anthem BCBS Setting Facility Modifier None Typical Low $380.19 Median $831.76 Typical High $3,630.78 | Facility | None | $380.19 | $831.76 | $3,630.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $74.13 Median $229.09 Typical High $407.38 | Professional | None | $74.13 | $229.09 | $407.38 |
CareSource Setting Facility Modifier None Typical Low $107.15 Median $125.89 Typical High $165.96 | Facility | None | $107.15 | $125.89 | $165.96 |
CareSource Setting Professional Modifier None Typical Low $91.20 Median $91.20 Typical High $102.33 | Professional | None | $91.20 | $91.20 | $102.33 |
Cigna Setting Facility Modifier None Typical Low $131.83 Median $229.09 Typical High $1,479.11 | Facility | None | $131.83 | $229.09 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $85.11 Median $234.42 Typical High $446.68 | Professional | None | $85.11 | $234.42 | $446.68 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $131.83 Median $223.87 Typical High $1,479.11 | Facility | None | $131.83 | $223.87 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $85.11 Median $223.87 Typical High $426.58 | Professional | None | $85.11 | $223.87 | $426.58 |
Molina Setting Professional Modifier None Typical Low $275.42 Median $354.81 Typical High $562.34 | Professional | None | $275.42 | $354.81 | $562.34 |
SummaCare Setting Facility Modifier None Typical Low $70.79 Median $74.13 Typical High $85.11 | Facility | None | $70.79 | $74.13 | $85.11 |
SummaCare Setting Professional Modifier None Typical Low $85.11 Median $128.82 Typical High $426.58 | Professional | None | $85.11 | $128.82 | $426.58 |
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 $75.86 Median $245.47 Typical High $457.09 | Professional | None | $75.86 | $245.47 | $457.09 |
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 $42.66 Median $158.49 Typical High $162.18 | Professional | 52 · Reduced service | $42.66 | $158.49 | $162.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $63.10 Typical High $66.07 | Professional | 53 · Discontinued | $17.38 | $63.10 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $64.57 Median $234.42 Typical High $245.47 | Professional | 54 · Surgery only | $64.57 | $234.42 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $46.77 Typical High $48.98 | Professional | 55 · Aftercare only | $12.88 | $46.77 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $31.62 Typical High $32.36 | Professional | 56 · Pre-op care only | $8.71 | $31.62 | $32.36 |
Where Ohio sits
The same service costs 4.8 times more in Wisconsin than in Washington, DC. 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· 27th 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.