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 $83.18 Median $194.98 Typical High $218.78 | Professional | None | $83.18 | $194.98 | $218.78 |
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 $51.29 Median $102.33 Typical High $181.97 | Professional | None | $51.29 | $102.33 | $181.97 |
CareSource Setting Facility Modifier None Typical Low $104.71 Median $1,348.96 Typical High $1,737.80 | Facility | None | $104.71 | $1,348.96 | $1,737.80 |
CareSource Setting Professional Modifier None Typical Low $89.13 Median $89.13 Typical High $100.00 | Professional | None | $89.13 | $89.13 | $100.00 |
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 $85.11 Median $165.96 Typical High $288.40 | Professional | None | $85.11 | $165.96 | $288.40 |
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 $85.11 Median $165.96 Typical High $275.42 | Professional | None | $85.11 | $165.96 | $275.42 |
Molina Setting Professional Modifier None Typical Low $158.49 Median $204.17 Typical High $316.23 | Professional | None | $158.49 | $204.17 | $316.23 |
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 $83.18 Median $125.89 Typical High $263.03 | Professional | None | $83.18 | $125.89 | $263.03 |
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 $70.79 Median $131.83 Typical High $234.42 | Professional | None | $70.79 | $131.83 | $234.42 |
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 $41.69 Median $97.72 Typical High $100.00 | Professional | 52 · Reduced service | $41.69 | $97.72 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $38.90 Typical High $39.81 | Professional | 53 · Discontinued | $16.60 | $38.90 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $147.91 Typical High $147.91 | Professional | 54 · Surgery only | $63.10 | $147.91 | $147.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $29.51 Typical High $29.51 | Professional | 55 · Aftercare only | $12.59 | $29.51 | $29.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $19.50 Typical High $19.95 | Professional | 56 · Pre-op care only | $8.32 | $19.50 | $19.95 |
Where Ohio sits
The same service costs 4.5 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· 48th of 51
$126
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.