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 $501.19 Median $3,235.94 Typical High $12,589.25 | Facility | None | $501.19 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $169.82 Typical High $2,630.27 | Professional | None | $144.54 | $169.82 | $2,630.27 |
Anthem BCBS Setting Facility Modifier None Typical Low $467.74 Median $1,071.52 Typical High $4,570.88 | Facility | None | $467.74 | $1,071.52 | $4,570.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $112.20 Median $134.90 Typical High $229.09 | Professional | None | $112.20 | $134.90 | $229.09 |
CareSource Setting Facility Modifier None Typical Low $194.98 Median $630.96 Typical High $831.76 | Facility | None | $194.98 | $630.96 | $831.76 |
Cigna Setting Facility Modifier None Typical Low $363.08 Median $707.95 Typical High $1,479.11 | Facility | None | $363.08 | $707.95 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $186.21 Typical High $354.81 | Professional | None | $147.91 | $186.21 | $354.81 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $389.05 Median $707.95 Typical High $1,479.11 | Facility | None | $389.05 | $707.95 | $1,479.11 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $147.91 Median $186.21 Typical High $354.81 | Professional | None | $147.91 | $186.21 | $354.81 |
Molina Setting Professional Modifier None Typical Low $138.04 Median $204.17 Typical High $295.12 | Professional | None | $138.04 | $204.17 | $295.12 |
SummaCare Setting Facility Modifier None Typical Low $338.84 Median $354.81 Typical High $407.38 | Facility | None | $338.84 | $354.81 | $407.38 |
SummaCare Setting Professional Modifier None Typical Low $144.54 Median $186.21 Typical High $239.88 | Professional | None | $144.54 | $186.21 | $239.88 |
United Setting Facility Modifier None Typical Low $501.19 Median $977.24 Typical High $4,677.35 | Facility | None | $501.19 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $128.82 Median $173.78 Typical High $331.13 | Professional | None | $128.82 | $173.78 | $331.13 |
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 $72.44 Median $85.11 Typical High $95.50 | Professional | 52 · Reduced service | $72.44 | $85.11 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $29.51 Median $33.88 Typical High $38.02 | Professional | 53 · Discontinued | $29.51 | $33.88 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $128.82 Typical High $141.25 | Professional | 54 · Surgery only | $109.65 | $128.82 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $25.70 Typical High $28.84 | Professional | 55 · Aftercare only | $21.88 | $25.70 | $28.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $16.98 Typical High $19.05 | Professional | 56 · Pre-op care only | $14.45 | $16.98 | $19.05 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $102.33 Median $120.23 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $102.33 | $120.23 | $131.83 |
Where Ohio sits
The same service costs 4.6 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· 41st of 51
$195
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.