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 $954.99 Median $2,454.71 Typical High $12,589.25 | Facility | None | $954.99 | $2,454.71 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $346.74 Median $346.74 Typical High $1,737.80 | Professional | None | $346.74 | $346.74 | $1,737.80 |
Anthem BCBS Setting Facility Modifier None Typical Low $741.31 Median $5,011.87 Typical High $11,481.54 | Facility | None | $741.31 | $5,011.87 | $11,481.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $346.74 Median $407.38 Typical High $676.08 | Professional | None | $346.74 | $407.38 | $676.08 |
CareSource Setting Facility Modifier None Typical Low $524.81 Median $524.81 Typical High $524.81 | Facility | None | $524.81 | $524.81 | $524.81 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,691.53 | Facility | None | $426.58 | $588.84 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $380.19 Median $436.52 Typical High $870.96 | Professional | None | $380.19 | $436.52 | $870.96 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,691.53 | Facility | None | $426.58 | $588.84 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $380.19 Median $436.52 Typical High $870.96 | Professional | None | $380.19 | $436.52 | $870.96 |
Molina Setting Professional Modifier None Typical Low $79.43 Median $346.74 Typical High $537.03 | Professional | None | $79.43 | $346.74 | $537.03 |
SummaCare Setting Professional Modifier None Typical Low $398.11 Median $398.11 Typical High $588.84 | Professional | None | $398.11 | $398.11 | $588.84 |
United Setting Facility Modifier None Typical Low $371.54 Median $977.24 Typical High $4,677.35 | Facility | None | $371.54 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $389.05 Median $467.74 Typical High $977.24 | Professional | None | $389.05 | $467.74 | $977.24 |
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 $169.82 Median $169.82 Typical High $831.76 | Professional | 52 · Reduced service | $169.82 | $169.82 | $831.76 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $69.18 Typical High $331.13 | Professional | 53 · Discontinued | $69.18 | $69.18 | $331.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $257.04 Median $257.04 Typical High $1,258.93 | Professional | 54 · Surgery only | $257.04 | $257.04 | $1,258.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $51.29 Median $51.29 Typical High $251.19 | Professional | 55 · Aftercare only | $51.29 | $51.29 | $251.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $34.67 Typical High $165.96 | Professional | 56 · Pre-op care only | $34.67 | $34.67 | $165.96 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $239.88 Median $239.88 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $239.88 | $239.88 | $1,174.90 |
Where Ohio sits
The same service costs 5.0 times more in Alaska than in Utah. 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· 49th of 51
$407
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.