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 $112.20 Median $3,235.94 Typical High $12,589.25 | Facility | None | $112.20 | $3,235.94 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $27.54 Median $28.84 Typical High $2,089.30 | Professional | None | $27.54 | $28.84 | $2,089.30 |
Anthem BCBS Setting Facility Modifier None Typical Low $549.54 Median $2,511.89 Typical High $18,620.87 | Facility | None | $549.54 | $2,511.89 | $18,620.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $22.91 Median $26.92 Typical High $42.66 | Professional | None | $22.91 | $26.92 | $42.66 |
CareSource Setting Facility Modifier None Typical Low $33.11 Median $537.03 Typical High $812.83 | Facility | None | $33.11 | $537.03 | $812.83 |
CareSource Setting Professional Modifier None Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | None | $28.18 | $28.18 | $28.18 |
Cigna Setting Facility Modifier None Typical Low $346.74 Median $549.54 Typical High $2,691.53 | Facility | None | $346.74 | $549.54 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $22.39 Median $30.90 Typical High $50.12 | Professional | None | $22.39 | $30.90 | $50.12 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $346.74 Median $524.81 Typical High $2,691.53 | Facility | None | $346.74 | $524.81 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $22.39 Median $30.90 Typical High $50.12 | Professional | None | $22.39 | $30.90 | $50.12 |
SummaCare Setting Professional Modifier None Typical Low $22.91 Median $29.51 Typical High $34.67 | Professional | None | $22.91 | $29.51 | $34.67 |
United Setting Facility Modifier None Typical Low $97.72 Median $257.04 Typical High $2,398.83 | Facility | None | $97.72 | $257.04 | $2,398.83 |
United Setting Professional Modifier None Typical Low $25.12 Median $29.51 Typical High $48.98 | Professional | None | $25.12 | $29.51 | $48.98 |
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 $13.80 Median $14.45 Typical High $14.45 | Professional | 52 · Reduced service | $13.80 | $14.45 | $14.45 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.50 Median $5.75 Typical High $5.75 | Professional | 53 · Discontinued | $5.50 | $5.75 | $5.75 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $20.42 Median $21.88 Typical High $21.88 | Professional | 54 · Surgery only | $20.42 | $21.88 | $21.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.07 Median $4.37 Typical High $4.37 | Professional | 55 · Aftercare only | $4.07 | $4.37 | $4.37 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.75 Median $2.88 Typical High $2.88 | Professional | 56 · Pre-op care only | $2.75 | $2.88 | $2.88 |
Where Ohio sits
The same service costs 4.1 times more in Alaska than in New Jersey. 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· 44th of 51
$29.51
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.