How much rates vary
Facilitymedian $398 · 10th to 90th $87 to $3,631Professionalmedian $110 · 10th to 90th $76 to $191
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 $144.54 Median $323.59 Typical High $12,589.25 | Facility | None | $144.54 | $323.59 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $117.49 Typical High $323.59 | Professional | None | $89.13 | $117.49 | $323.59 |
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 $58.88 Median $104.71 Typical High $162.18 | Professional | None | $58.88 | $104.71 | $162.18 |
CareSource Setting Facility Modifier None Typical Low $70.79 Median $93.33 Typical High $107.15 | Facility | None | $70.79 | $93.33 | $107.15 |
Cigna Setting Facility Modifier None Typical Low $77.62 Median $138.04 Typical High $1,479.11 | Facility | None | $77.62 | $138.04 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $117.49 Typical High $229.09 | Professional | None | $79.43 | $117.49 | $229.09 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $77.62 Median $144.54 Typical High $1,479.11 | Facility | None | $77.62 | $144.54 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $79.43 Median $117.49 Typical High $239.88 | Professional | None | $79.43 | $117.49 | $239.88 |
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 $41.69 Median $43.65 Typical High $50.12 | Facility | None | $41.69 | $43.65 | $50.12 |
SummaCare Setting Professional Modifier None Typical Low $83.18 Median $120.23 Typical High $154.88 | Professional | None | $83.18 | $120.23 | $154.88 |
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 $77.62 Median $112.20 Typical High $208.93 | Professional | None | $77.62 | $112.20 | $208.93 |
7 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 $44.67 Median $58.88 Typical High $58.88 | Professional | 52 · Reduced service | $44.67 | $58.88 | $58.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.78 Median $23.44 Typical High $23.44 | Professional | 53 · Discontinued | $17.78 | $23.44 | $23.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $66.07 Median $89.13 Typical High $89.13 | Professional | 54 · Surgery only | $66.07 | $89.13 | $89.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $17.78 Typical High $17.78 | Professional | 55 · Aftercare only | $13.49 | $17.78 | $17.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $11.75 Typical High $11.75 | Professional | 56 · Pre-op care only | $8.91 | $11.75 | $11.75 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $61.66 Median $83.18 Typical High $83.18 | Professional | 78 · Unplanned return to OR | $61.66 | $83.18 | $83.18 |
Ambetter Setting Professional Modifier 58 · Staged procedure Typical Low $151.36 Median $151.36 Typical High $162.18 | Professional | 58 · Staged procedure | $151.36 | $151.36 | $162.18 |
Where Ohio sits
The same service costs 3.3 times more in Alaska than in Pennsylvania. 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
$117
AK $355PA $107
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.