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 $467.74 Median $2,691.53 Typical High $10,964.78 | Facility | None | $467.74 | $2,691.53 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $223.87 Typical High $1,071.52 | Professional | None | $169.82 | $223.87 | $1,071.52 |
Anthem BCBS Setting Facility Modifier None Typical Low $426.58 Median $912.01 Typical High $3,715.35 | Facility | None | $426.58 | $912.01 | $3,715.35 |
Anthem BCBS Setting Professional Modifier None Typical Low $134.90 Median $169.82 Typical High $288.40 | Professional | None | $134.90 | $169.82 | $288.40 |
CareSource Setting Facility Modifier None Typical Low $234.42 Median $457.09 Typical High $602.56 | Facility | None | $234.42 | $457.09 | $602.56 |
Cigna Setting Facility Modifier None Typical Low $457.09 Median $562.34 Typical High $1,995.26 | Facility | None | $457.09 | $562.34 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $257.04 Typical High $407.38 | Professional | None | $204.17 | $257.04 | $407.38 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $457.09 Median $562.34 Typical High $1,995.26 | Facility | None | $457.09 | $562.34 | $1,995.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $204.17 Median $257.04 Typical High $407.38 | Professional | None | $204.17 | $257.04 | $407.38 |
Molina Setting Professional Modifier None Typical Low $181.97 Median $263.03 Typical High $389.05 | Professional | None | $181.97 | $263.03 | $389.05 |
SummaCare Setting Facility Modifier None Typical Low $251.19 Median $263.03 Typical High $295.12 | Facility | None | $251.19 | $263.03 | $295.12 |
SummaCare Setting Professional Modifier None Typical Low $186.21 Median $245.47 Typical High $323.59 | Professional | None | $186.21 | $245.47 | $323.59 |
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 $131.83 Median $218.78 Typical High $380.19 | Professional | None | $131.83 | $218.78 | $380.19 |
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 $85.11 Median $112.20 Typical High $128.82 | Professional | 52 · Reduced service | $85.11 | $112.20 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $44.67 Typical High $51.29 | Professional | 53 · Discontinued | $33.88 | $44.67 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $169.82 Typical High $190.55 | Professional | 54 · Surgery only | $128.82 | $169.82 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $33.88 Typical High $38.02 | Professional | 55 · Aftercare only | $25.70 | $33.88 | $38.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $22.39 Typical High $25.70 | Professional | 56 · Pre-op care only | $16.98 | $22.39 | $25.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $158.49 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $120.23 | $158.49 | $177.83 |
Where Ohio sits
The same service costs 4.3 times more in Alaska 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· 36th of 51
$245
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.