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 $223.87 Median $575.44 Typical High $10,715.19 | Facility | None | $223.87 | $575.44 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $117.49 Median $169.82 Typical High $616.60 | Professional | None | $117.49 | $169.82 | $616.60 |
Ambetter Setting Professional Modifier None Typical Low $141.25 Median $173.78 Typical High $190.55 | Professional | None | $141.25 | $173.78 | $190.55 |
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 $102.33 Median $144.54 Typical High $239.88 | Professional | None | $102.33 | $144.54 | $239.88 |
CareSource Setting Facility Modifier None Typical Low $87.10 Median $112.20 Typical High $151.36 | Facility | None | $87.10 | $112.20 | $151.36 |
Cigna Setting Facility Modifier None Typical Low $93.33 Median $165.96 Typical High $1,479.11 | Facility | None | $93.33 | $165.96 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $123.03 Median $181.97 Typical High $323.59 | Professional | None | $123.03 | $181.97 | $323.59 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $93.33 Median $165.96 Typical High $1,479.11 | Facility | None | $93.33 | $165.96 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $123.03 Median $181.97 Typical High $331.13 | Professional | None | $123.03 | $181.97 | $331.13 |
Molina Setting Professional Modifier None Typical Low $154.88 Median $204.17 Typical High $275.42 | Professional | None | $154.88 | $204.17 | $275.42 |
SummaCare Setting Facility Modifier None Typical Low $50.12 Median $52.48 Typical High $58.88 | Facility | None | $50.12 | $52.48 | $58.88 |
SummaCare Setting Professional Modifier None Typical Low $112.20 Median $181.97 Typical High $239.88 | Professional | None | $112.20 | $181.97 | $239.88 |
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 $120.23 Median $173.78 Typical High $309.03 | Professional | None | $120.23 | $173.78 | $309.03 |
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 $58.88 Median $85.11 Typical High $85.11 | Professional | 52 · Reduced service | $58.88 | $85.11 | $85.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $33.88 Typical High $33.88 | Professional | 53 · Discontinued | $23.99 | $33.88 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $128.82 Typical High $128.82 | Professional | 54 · Surgery only | $89.13 | $128.82 | $128.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.78 Median $25.70 Typical High $25.70 | Professional | 55 · Aftercare only | $17.78 | $25.70 | $25.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.75 Median $16.98 Typical High $16.98 | Professional | 56 · Pre-op care only | $11.75 | $16.98 | $16.98 |
Where Ohio sits
The same service costs 3.7 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· 43rd of 51
$174
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.