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 $162.18 Median $371.54 Typical High $12,589.25 | Facility | None | $162.18 | $371.54 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $58.88 Median $128.82 Typical High $380.19 | Professional | None | $58.88 | $128.82 | $380.19 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $1,122.02 Typical High $4,570.88 | Facility | None | $524.81 | $1,122.02 | $4,570.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $53.70 Median $63.10 Typical High $100.00 | Professional | None | $53.70 | $63.10 | $100.00 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $79.43 Median $93.33 Typical High $147.91 | Professional | 50 · Both sides | $79.43 | $93.33 | $147.91 |
CareSource Setting Facility Modifier None Typical Low $79.43 Median $102.33 Typical High $131.83 | Facility | None | $79.43 | $102.33 | $131.83 |
Cigna Setting Facility Modifier None Typical Low $107.15 Median $169.82 Typical High $2,398.83 | Facility | None | $107.15 | $169.82 | $2,398.83 |
Cigna Setting Professional Modifier None Typical Low $61.66 Median $134.90 Typical High $251.19 | Professional | None | $61.66 | $134.90 | $251.19 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $107.15 Median $169.82 Typical High $2,398.83 | Facility | None | $107.15 | $169.82 | $2,398.83 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $61.66 Median $134.90 Typical High $257.04 | Professional | None | $61.66 | $134.90 | $257.04 |
Molina Setting Professional Modifier None Typical Low $125.89 Median $162.18 Typical High $218.78 | Professional | None | $125.89 | $162.18 | $218.78 |
SummaCare Setting Facility Modifier None Typical Low $58.88 Median $61.66 Typical High $69.18 | Facility | None | $58.88 | $61.66 | $69.18 |
SummaCare Setting Professional Modifier None Typical Low $57.54 Median $141.25 Typical High $181.97 | Professional | None | $57.54 | $141.25 | $181.97 |
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 $60.26 Median $117.49 Typical High $245.47 | Professional | None | $60.26 | $117.49 | $245.47 |
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 $29.51 Median $64.57 Typical High $67.61 | Professional | 52 · Reduced service | $29.51 | $64.57 | $67.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.75 Median $25.70 Typical High $26.92 | Professional | 53 · Discontinued | $11.75 | $25.70 | $26.92 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $43.65 Median $97.72 Typical High $102.33 | Professional | 54 · Surgery only | $43.65 | $97.72 | $102.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.91 Median $19.50 Typical High $20.42 | Professional | 55 · Aftercare only | $8.91 | $19.50 | $20.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.89 Median $12.88 Typical High $13.49 | Professional | 56 · Pre-op care only | $5.89 | $12.88 | $13.49 |
Where Ohio sits
The same service costs 5.9 times more in Oklahoma 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· 41st of 51
$132
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.