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 $295.12 Median $3,235.94 Typical High $12,589.25 | Facility | None | $295.12 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $39.81 Median $151.36 Typical High $173.78 | Professional | None | $39.81 | $151.36 | $173.78 |
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 $36.31 Median $70.79 Typical High $120.23 | Professional | None | $36.31 | $70.79 | $120.23 |
CareSource Setting Facility Modifier None Typical Low $48.98 Median $724.44 Typical High $1,096.48 | Facility | None | $48.98 | $724.44 | $1,096.48 |
CareSource Setting Professional Modifier None Typical Low $41.69 Median $41.69 Typical High $46.77 | Professional | None | $41.69 | $41.69 | $46.77 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $794.33 | Facility | None | $50.12 | $66.07 | $794.33 |
Cigna Setting Professional Modifier None Typical Low $39.81 Median $125.89 Typical High $218.78 | Professional | None | $39.81 | $125.89 | $218.78 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $794.33 | Facility | None | $50.12 | $66.07 | $794.33 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $39.81 Median $128.82 Typical High $208.93 | Professional | None | $39.81 | $128.82 | $208.93 |
Molina Setting Professional Modifier None Typical Low $131.83 Median $169.82 Typical High $269.15 | Professional | None | $131.83 | $169.82 | $269.15 |
SummaCare Setting Professional Modifier None Typical Low $38.02 Median $57.54 Typical High $190.55 | Professional | None | $38.02 | $57.54 | $190.55 |
United Setting Facility Modifier None Typical Low $363.08 Median $691.83 Typical High $3,311.31 | Facility | None | $363.08 | $691.83 | $3,311.31 |
United Setting Professional Modifier None Typical Low $35.48 Median $83.18 Typical High $181.97 | Professional | None | $35.48 | $83.18 | $181.97 |
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 $19.95 Median $75.86 Typical High $75.86 | Professional | 52 · Reduced service | $19.95 | $75.86 | $75.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $30.20 Typical High $30.20 | Professional | 53 · Discontinued | $7.94 | $30.20 | $30.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $29.51 Median $112.20 Typical High $114.82 | Professional | 54 · Surgery only | $29.51 | $112.20 | $114.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.89 Median $22.91 Typical High $22.91 | Professional | 55 · Aftercare only | $5.89 | $22.91 | $22.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.98 Median $15.14 Typical High $15.14 | Professional | 56 · Pre-op care only | $3.98 | $15.14 | $15.14 |
Where Ohio sits
The same service costs 4.6 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· 44th of 51
$89.13
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.