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 $416.87 Median $3,235.94 Typical High $12,589.25 | Facility | None | $416.87 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $79.43 Median $131.83 Typical High $1,905.46 | Professional | None | $79.43 | $131.83 | $1,905.46 |
Anthem BCBS Setting Facility Modifier None Typical Low $371.54 Median $831.76 Typical High $3,311.31 | Facility | None | $371.54 | $831.76 | $3,311.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $74.13 Median $131.83 Typical High $218.78 | Professional | None | $74.13 | $131.83 | $218.78 |
CareSource Setting Facility Modifier None Typical Low $97.72 Median $302.00 Typical High $398.11 | Facility | None | $97.72 | $302.00 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $295.12 Median $398.11 Typical High $1,479.11 | Facility | None | $295.12 | $398.11 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $131.83 Typical High $281.84 | Professional | None | $75.86 | $131.83 | $281.84 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $295.12 Median $398.11 Typical High $1,479.11 | Facility | None | $295.12 | $398.11 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $75.86 Median $131.83 Typical High $295.12 | Professional | None | $75.86 | $131.83 | $295.12 |
Molina Setting Professional Modifier None Typical Low $120.23 Median $162.18 Typical High $218.78 | Professional | None | $120.23 | $162.18 | $218.78 |
SummaCare Setting Facility Modifier None Typical Low $158.49 Median $165.96 Typical High $190.55 | Facility | None | $158.49 | $165.96 | $190.55 |
SummaCare Setting Professional Modifier None Typical Low $74.13 Median $138.04 Typical High $181.97 | Professional | None | $74.13 | $138.04 | $181.97 |
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 $83.18 Median $134.90 Typical High $257.04 | Professional | None | $83.18 | $134.90 | $257.04 |
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 $39.81 Median $66.07 Typical High $67.61 | Professional | 52 · Reduced service | $39.81 | $66.07 | $67.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.85 Median $26.30 Typical High $27.54 | Professional | 53 · Discontinued | $15.85 | $26.30 | $27.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $60.26 Median $100.00 Typical High $102.33 | Professional | 54 · Surgery only | $60.26 | $100.00 | $102.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.02 Median $19.95 Typical High $20.42 | Professional | 55 · Aftercare only | $12.02 | $19.95 | $20.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.94 Median $13.18 Typical High $13.80 | Professional | 56 · Pre-op care only | $7.94 | $13.18 | $13.80 |
Where Ohio sits
The same service costs 3.6 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· 35th of 51
$151
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.