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 $263.03 Median $2,630.27 Typical High $12,022.64 | Facility | None | $263.03 | $2,630.27 | $12,022.64 |
Aetna Setting Professional Modifier None Typical Low $141.25 Median $141.25 Typical High $4,073.80 | Professional | None | $141.25 | $141.25 | $4,073.80 |
Anthem BCBS Setting Facility Modifier None Typical Low $371.54 Median $831.76 Typical High $3,311.31 | Facility | None | $371.54 | $831.76 | $3,311.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $204.17 Median $239.88 Typical High $389.05 | Professional | None | $204.17 | $239.88 | $389.05 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $128.82 Median $151.36 Typical High $251.19 | Professional | 62 · Two surgeons | $128.82 | $151.36 | $251.19 |
CareSource Setting Facility Modifier None Typical Low $446.68 Median $446.68 Typical High $588.84 | Facility | None | $446.68 | $446.68 | $588.84 |
Cigna Setting Facility Modifier None Typical Low $389.05 Median $549.54 Typical High $1,479.11 | Facility | None | $389.05 | $549.54 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $141.25 Median $186.21 Typical High $309.03 | Professional | None | $141.25 | $186.21 | $309.03 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $389.05 Median $549.54 Typical High $1,479.11 | Facility | None | $389.05 | $549.54 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $141.25 Median $186.21 Typical High $309.03 | Professional | None | $141.25 | $186.21 | $309.03 |
Molina Setting Professional Modifier None Typical Low $50.12 Median $50.12 Typical High $60.26 | Professional | None | $50.12 | $50.12 | $60.26 |
SummaCare Setting Facility Modifier None Typical Low $263.03 Median $275.42 Typical High $309.03 | Facility | None | $263.03 | $275.42 | $309.03 |
SummaCare Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $229.09 | Professional | None | $229.09 | $229.09 | $229.09 |
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 $128.82 Median $154.88 Typical High $363.08 | Professional | None | $128.82 | $154.88 | $363.08 |
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 $70.79 Median $70.79 Typical High $602.56 | Professional | 52 · Reduced service | $70.79 | $70.79 | $602.56 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $28.18 Typical High $239.88 | Professional | 53 · Discontinued | $28.18 | $28.18 | $239.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $107.15 Typical High $891.25 | Professional | 54 · Surgery only | $107.15 | $107.15 | $891.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $21.38 Typical High $181.97 | Professional | 55 · Aftercare only | $21.38 | $21.38 | $181.97 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $14.13 Typical High $120.23 | Professional | 56 · Pre-op care only | $14.13 | $14.13 | $120.23 |
Where Ohio sits
The same service costs 4.3 times more in Alaska than in New York. 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· 27th of 51
$251
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.