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 $501.19 Median $3,235.94 Typical High $12,589.25 | Facility | None | $501.19 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $100.00 Median $204.17 Typical High $229.09 | Professional | None | $100.00 | $204.17 | $229.09 |
Anthem BCBS Setting Facility Modifier None Typical Low $489.78 Median $1,230.27 Typical High $4,466.84 | Facility | None | $489.78 | $1,230.27 | $4,466.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $57.54 Median $131.83 Typical High $218.78 | Professional | None | $57.54 | $131.83 | $218.78 |
CareSource Setting Facility Modifier None Typical Low $125.89 Median $1,348.96 Typical High $1,737.80 | Facility | None | $125.89 | $1,348.96 | $1,737.80 |
CareSource Setting Professional Modifier None Typical Low $104.71 Median $104.71 Typical High $120.23 | Professional | None | $104.71 | $104.71 | $120.23 |
Cigna Setting Facility Modifier None Typical Low $363.08 Median $1,479.11 Typical High $2,290.87 | Facility | None | $363.08 | $1,479.11 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $181.97 Typical High $302.00 | Professional | None | $97.72 | $181.97 | $302.00 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $389.05 Median $1,479.11 Typical High $2,187.76 | Facility | None | $389.05 | $1,479.11 | $2,187.76 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $97.72 Median $181.97 Typical High $281.84 | Professional | None | $97.72 | $181.97 | $281.84 |
Molina Setting Professional Modifier None Typical Low $186.21 Median $234.42 Typical High $371.54 | Professional | None | $186.21 | $234.42 | $371.54 |
SummaCare Setting Facility Modifier None Typical Low $741.31 Median $776.25 Typical High $870.96 | Facility | None | $741.31 | $776.25 | $870.96 |
SummaCare Setting Professional Modifier None Typical Low $97.72 Median $147.91 Typical High $275.42 | Professional | None | $97.72 | $147.91 | $275.42 |
United Setting Facility Modifier None Typical Low $691.83 Median $1,445.44 Typical High $6,165.95 | Facility | None | $691.83 | $1,445.44 | $6,165.95 |
United Setting Professional Modifier None Typical Low $85.11 Median $151.36 Typical High $251.19 | Professional | None | $85.11 | $151.36 | $251.19 |
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 $50.12 Median $102.33 Typical High $104.71 | Professional | 52 · Reduced service | $50.12 | $102.33 | $104.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $40.74 Typical High $41.69 | Professional | 53 · Discontinued | $19.95 | $40.74 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $154.88 Typical High $158.49 | Professional | 54 · Surgery only | $74.13 | $154.88 | $158.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $30.90 Typical High $31.62 | Professional | 55 · Aftercare only | $14.79 | $30.90 | $31.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $20.42 Typical High $20.89 | Professional | 56 · Pre-op care only | $10.00 | $20.42 | $20.89 |
Where Ohio sits
The same service costs 4.0 times more in Alaska 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· 46th of 51
$155
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.