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 $275.42 Median $977.24 Typical High $10,232.93 | Facility | None | $275.42 | $977.24 | $10,232.93 |
Aetna Setting Professional Modifier None Typical Low $151.36 Median $316.23 Typical High $1,318.26 | Professional | None | $151.36 | $316.23 | $1,318.26 |
Ambetter Setting Professional Modifier None Typical Low $125.89 Median $208.93 Typical High $208.93 | Professional | None | $125.89 | $208.93 | $208.93 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $1,148.15 Typical High $4,570.88 | Facility | None | $524.81 | $1,148.15 | $4,570.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $144.54 Median $281.84 Typical High $467.74 | Professional | None | $144.54 | $281.84 | $467.74 |
CareSource Setting Facility Modifier None Typical Low $186.21 Median $933.25 Typical High $1,202.26 | Facility | None | $186.21 | $933.25 | $1,202.26 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $1,071.52 Typical High $1,995.26 | Facility | None | $489.78 | $1,071.52 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $295.12 Typical High $524.81 | Professional | None | $147.91 | $295.12 | $524.81 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $512.86 Median $1,071.52 Typical High $2,137.96 | Facility | None | $512.86 | $1,071.52 | $2,137.96 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $147.91 Median $295.12 Typical High $524.81 | Professional | None | $147.91 | $295.12 | $524.81 |
Molina Setting Professional Modifier None Typical Low $275.42 Median $363.08 Typical High $489.78 | Professional | None | $275.42 | $363.08 | $489.78 |
SummaCare Setting Facility Modifier None Typical Low $512.86 Median $537.03 Typical High $616.60 | Facility | None | $512.86 | $537.03 | $616.60 |
SummaCare Setting Professional Modifier None Typical Low $141.25 Median $309.03 Typical High $478.63 | Professional | None | $141.25 | $309.03 | $478.63 |
United Setting Facility Modifier None Typical Low $501.19 Median $977.24 Typical High $4,677.35 | Facility | None | $501.19 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $158.49 Median $295.12 Typical High $549.54 | Professional | None | $158.49 | $295.12 | $549.54 |
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 $75.86 Median $158.49 Typical High $158.49 | Professional | 52 · Reduced service | $75.86 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $63.10 Typical High $63.10 | Professional | 53 · Discontinued | $30.20 | $63.10 | $63.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $234.42 Typical High $234.42 | Professional | 54 · Surgery only | $112.20 | $234.42 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $47.86 Typical High $47.86 | Professional | 55 · Aftercare only | $22.39 | $47.86 | $47.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $31.62 Typical High $31.62 | Professional | 56 · Pre-op care only | $15.14 | $31.62 | $31.62 |
Where Ohio sits
The same service costs 3.0 times more in Wisconsin than in Utah. 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
$331
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.