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 $302.00 Median $2,691.53 Typical High $10,964.78 | Facility | None | $302.00 | $2,691.53 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $162.18 Typical High $2,630.27 | Professional | None | $109.65 | $162.18 | $2,630.27 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $1,174.90 Typical High $4,570.88 | Facility | None | $524.81 | $1,174.90 | $4,570.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $100.00 Median $134.90 Typical High $223.87 | Professional | None | $100.00 | $134.90 | $223.87 |
CareSource Setting Facility Modifier None Typical Low $87.10 Median $112.20 Typical High $138.04 | Facility | None | $87.10 | $112.20 | $138.04 |
Cigna Setting Facility Modifier None Typical Low $87.10 Median $138.04 Typical High $2,398.83 | Facility | None | $87.10 | $138.04 | $2,398.83 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $169.82 Typical High $295.12 | Professional | None | $114.82 | $169.82 | $295.12 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $87.10 Median $138.04 Typical High $2,398.83 | Facility | None | $87.10 | $138.04 | $2,398.83 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $114.82 Median $169.82 Typical High $309.03 | Professional | None | $114.82 | $169.82 | $309.03 |
Molina Setting Professional Modifier None Typical Low $104.71 Median $162.18 Typical High $239.88 | Professional | None | $104.71 | $162.18 | $239.88 |
SummaCare Setting Facility Modifier None Typical Low $46.77 Median $48.98 Typical High $56.23 | Facility | None | $46.77 | $48.98 | $56.23 |
SummaCare Setting Professional Modifier None Typical Low $104.71 Median $162.18 Typical High $213.80 | Professional | None | $104.71 | $162.18 | $213.80 |
United Setting Facility Modifier None Typical Low $691.83 Median $1,445.44 Typical High $6,165.95 | Facility | None | $691.83 | $1,445.44 | $6,165.95 |
United Setting Professional Modifier None Typical Low $109.65 Median $154.88 Typical High $288.40 | Professional | None | $109.65 | $154.88 | $288.40 |
6 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 $54.95 Median $77.62 Typical High $79.43 | Professional | 52 · Reduced service | $54.95 | $77.62 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $30.90 Typical High $32.36 | Professional | 53 · Discontinued | $21.88 | $30.90 | $32.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $114.82 Typical High $120.23 | Professional | 54 · Surgery only | $83.18 | $114.82 | $120.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $22.91 Typical High $23.99 | Professional | 55 · Aftercare only | $16.60 | $22.91 | $23.99 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $15.49 Typical High $16.22 | Professional | 56 · Pre-op care only | $10.96 | $15.49 | $16.22 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $77.62 Median $107.15 Typical High $112.20 | Professional | 78 · Unplanned return to OR | $77.62 | $107.15 | $112.20 |
Where Ohio sits
The same service costs 3.6 times more in Wisconsin than in Texas. 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· 41st of 51
$158
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.