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 $117.49 Median $331.13 Typical High $10,715.19 | Facility | None | $117.49 | $331.13 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $63.10 Median $100.00 Typical High $331.13 | Professional | None | $63.10 | $100.00 | $331.13 |
Ambetter Setting Professional Modifier None Typical Low $75.86 Median $112.20 Typical High $112.20 | Professional | None | $75.86 | $112.20 | $112.20 |
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 $87.10 Typical High $138.04 | Professional | None | $58.88 | $87.10 | $138.04 |
CareSource Setting Facility Modifier None Typical Low $53.70 Median $69.18 Typical High $81.28 | Facility | None | $53.70 | $69.18 | $81.28 |
Cigna Setting Facility Modifier None Typical Low $57.54 Median $102.33 Typical High $1,479.11 | Facility | None | $57.54 | $102.33 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $66.07 Median $102.33 Typical High $194.98 | Professional | None | $66.07 | $102.33 | $194.98 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $57.54 Median $102.33 Typical High $1,479.11 | Facility | None | $57.54 | $102.33 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $66.07 Median $104.71 Typical High $194.98 | Professional | None | $66.07 | $104.71 | $194.98 |
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 $30.20 Median $31.62 Typical High $36.31 | Facility | None | $30.20 | $31.62 | $36.31 |
SummaCare Setting Professional Modifier None Typical Low $60.26 Median $104.71 Typical High $134.90 | Professional | None | $60.26 | $104.71 | $134.90 |
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 $64.57 Median $97.72 Typical High $177.83 | Professional | None | $64.57 | $97.72 | $177.83 |
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 $31.62 Median $50.12 Typical High $50.12 | Professional | 52 · Reduced service | $31.62 | $50.12 | $50.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.88 Median $19.95 Typical High $19.95 | Professional | 53 · Discontinued | $12.88 | $19.95 | $19.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $47.86 Median $74.13 Typical High $74.13 | Professional | 54 · Surgery only | $47.86 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.55 Median $14.79 Typical High $14.79 | Professional | 55 · Aftercare only | $9.55 | $14.79 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.31 Median $10.00 Typical High $10.00 | Professional | 56 · Pre-op care only | $6.31 | $10.00 | $10.00 |
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· 42nd of 51
$100
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.