How much rates vary
Facilitymedian $417 · 10th to 90th $74 to $3,715Professionalmedian $98 · 10th to 90th $51 to $174
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 $95.50 Median $316.23 Typical High $10,715.19 | Facility | None | $95.50 | $316.23 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $51.29 Median $95.50 Typical High $316.23 | Professional | None | $51.29 | $95.50 | $316.23 |
Ambetter Setting Professional Modifier None Typical Low $64.57 Median $114.82 Typical High $134.90 | Professional | None | $64.57 | $114.82 | $134.90 |
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 $51.29 Median $83.18 Typical High $147.91 | Professional | None | $51.29 | $83.18 | $147.91 |
CareSource Setting Facility Modifier None Typical Low $60.26 Median $64.57 Typical High $77.62 | Facility | None | $60.26 | $64.57 | $77.62 |
Cigna Setting Facility Modifier None Typical Low $66.07 Median $117.49 Typical High $1,479.11 | Facility | None | $66.07 | $117.49 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $50.12 Median $89.13 Typical High $181.97 | Professional | None | $50.12 | $89.13 | $181.97 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $66.07 Median $117.49 Typical High $1,479.11 | Facility | None | $66.07 | $117.49 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $50.12 Median $93.33 Typical High $181.97 | Professional | None | $50.12 | $93.33 | $181.97 |
Molina Setting Professional Modifier None Typical Low $91.20 Median $120.23 Typical High $165.96 | Professional | None | $91.20 | $120.23 | $165.96 |
SummaCare Setting Facility Modifier None Typical Low $35.48 Median $37.15 Typical High $41.69 | Facility | None | $35.48 | $37.15 | $41.69 |
SummaCare Setting Professional Modifier None Typical Low $47.86 Median $100.00 Typical High $169.82 | Professional | None | $47.86 | $100.00 | $169.82 |
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 $53.70 Median $97.72 Typical High $177.83 | Professional | None | $53.70 | $97.72 | $177.83 |
6 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 $25.70 Median $47.86 Typical High $48.98 | Professional | 52 · Reduced service | $25.70 | $47.86 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $19.05 Typical High $19.50 | Professional | 53 · Discontinued | $10.23 | $19.05 | $19.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.90 Median $70.79 Typical High $72.44 | Professional | 54 · Surgery only | $38.90 | $70.79 | $72.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $14.13 Typical High $14.45 | Professional | 55 · Aftercare only | $7.76 | $14.13 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $9.55 Typical High $9.77 | Professional | 56 · Pre-op care only | $5.13 | $9.55 | $9.77 |
Ambetter Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $114.82 Typical High $114.82 | Professional | 78 · Unplanned return to OR | $114.82 | $114.82 | $114.82 |
Where Ohio sits
The same service costs 2.8 times more in Wisconsin than in Kentucky. 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· 36th of 51
$102
WI $257KY $91.20
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.