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 $10,232.93 Typical High $13,803.84 | Facility | None | $295.12 | $10,232.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $1,621.81 | Professional | None | $245.47 | $245.47 | $1,621.81 |
Anthem BCBS Setting Facility Modifier None Typical Low $645.65 Median $1,659.59 Typical High $7,585.78 | Facility | None | $645.65 | $1,659.59 | $7,585.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $208.93 Median $245.47 Typical High $346.74 | Professional | None | $208.93 | $245.47 | $346.74 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $131.83 Median $154.88 Typical High $223.87 | Professional | 62 · Two surgeons | $131.83 | $154.88 | $223.87 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $33.11 Median $38.90 Typical High $56.23 | Professional | 80 · Assistant surgeon | $33.11 | $38.90 | $56.23 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $29.51 Median $34.67 Typical High $48.98 | Professional | AS · PA/NP assist | $29.51 | $34.67 | $48.98 |
CareSource Setting Facility Modifier None Typical Low $234.42 Median $302.00 Typical High $79,432.82 | Facility | None | $234.42 | $302.00 | $79,432.82 |
CareSource Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $295.12 | Professional | None | $257.04 | $257.04 | $295.12 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,691.53 | Facility | None | $426.58 | $588.84 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $234.42 Median $245.47 Typical High $380.19 | Professional | None | $234.42 | $245.47 | $380.19 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $2,691.53 | Facility | None | $426.58 | $602.56 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $234.42 Median $245.47 Typical High $380.19 | Professional | None | $234.42 | $245.47 | $380.19 |
Molina Setting Professional Modifier None Typical Low $85.11 Median $123.03 Typical High $158.49 | Professional | None | $85.11 | $123.03 | $158.49 |
SummaCare Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $269.15 | Professional | None | $229.09 | $229.09 | $269.15 |
United Setting Facility Modifier None Typical Low $371.54 Median $977.24 Typical High $4,677.35 | Facility | None | $371.54 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $173.78 Median $229.09 Typical High $346.74 | Professional | None | $173.78 | $229.09 | $346.74 |
3 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 54 · Surgery only Typical Low $186.21 Median $186.21 Typical High $295.12 | Professional | 54 · Surgery only | $186.21 | $186.21 | $295.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $37.15 Median $37.15 Typical High $58.88 | Professional | 55 · Aftercare only | $37.15 | $37.15 | $58.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $24.55 Median $24.55 Typical High $39.81 | Professional | 56 · Pre-op care only | $24.55 | $24.55 | $39.81 |
Where Ohio sits
The same service costs 8.1 times more in New York than in Missouri. 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· 45th of 51
$245
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.