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 $707.95 Median $4,365.16 Typical High $12,589.25 | Facility | None | $707.95 | $4,365.16 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $338.84 Typical High $3,548.13 | Professional | None | $194.98 | $338.84 | $3,548.13 |
Ambetter Setting Professional Modifier None Typical Low $478.63 Median $478.63 Typical High $478.63 | Professional | None | $478.63 | $478.63 | $478.63 |
Anthem BCBS Setting Facility Modifier None Typical Low $457.09 Median $1,000.00 Typical High $3,715.35 | Facility | None | $457.09 | $1,000.00 | $3,715.35 |
Anthem BCBS Setting Professional Modifier None Typical Low $158.49 Median $239.88 Typical High $436.52 | Professional | None | $158.49 | $239.88 | $436.52 |
CareSource Setting Facility Modifier None Typical Low $239.88 Median $302.00 Typical High $398.11 | Facility | None | $239.88 | $302.00 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $295.12 Median $457.09 Typical High $1,995.26 | Facility | None | $295.12 | $457.09 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $190.55 Median $309.03 Typical High $588.84 | Professional | None | $190.55 | $309.03 | $588.84 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $302.00 Median $457.09 Typical High $1,995.26 | Facility | None | $302.00 | $457.09 | $1,995.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $190.55 Median $309.03 Typical High $616.60 | Professional | None | $190.55 | $309.03 | $616.60 |
Molina Setting Professional Modifier None Typical Low $316.23 Median $407.38 Typical High $549.54 | Professional | None | $316.23 | $407.38 | $549.54 |
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 $177.83 Median $323.59 Typical High $426.58 | Professional | None | $177.83 | $323.59 | $426.58 |
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 $204.17 Median $309.03 Typical High $575.44 | Professional | None | $204.17 | $309.03 | $575.44 |
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 $97.72 Median $169.82 Typical High $169.82 | Professional | 52 · Reduced service | $97.72 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $67.61 Typical High $67.61 | Professional | 53 · Discontinued | $38.90 | $67.61 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $257.04 Typical High $257.04 | Professional | 54 · Surgery only | $144.54 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $51.29 Typical High $51.29 | Professional | 55 · Aftercare only | $28.84 | $51.29 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $33.88 Typical High $33.88 | Professional | 56 · Pre-op care only | $19.50 | $33.88 | $33.88 |
Where Ohio sits
The same service costs 3.0 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· 44th 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.