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 $234.42 Median $6,918.31 Typical High $12,589.25 | Facility | None | $234.42 | $6,918.31 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $707.95 | Professional | None | $204.17 | $204.17 | $707.95 |
Anthem BCBS Setting Professional Modifier None Typical Low $257.04 Median $263.03 Typical High $416.87 | Professional | None | $257.04 | $263.03 | $416.87 |
CareSource Setting Professional Modifier None Typical Low $245.47 Median $263.03 Typical High $281.84 | Professional | None | $245.47 | $263.03 | $281.84 |
Cigna Setting Professional Modifier None Typical Low $288.40 Median $346.74 Typical High $346.74 | Professional | None | $288.40 | $346.74 | $346.74 |
Molina Setting Professional Modifier None Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | None | $60.26 | $60.26 | $60.26 |
SummaCare Setting Facility Modifier None Typical Low $181.97 Median $190.55 Typical High $213.80 | Facility | None | $181.97 | $190.55 | $213.80 |
10 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 Facility Modifier 52 · Reduced service Typical Low $102.33 Median $190.55 Typical High $269.15 | Facility | 52 · Reduced service | $102.33 | $190.55 | $269.15 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $41.69 Median $75.86 Typical High $107.15 | Facility | 53 · Discontinued | $41.69 | $75.86 | $107.15 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $154.88 Median $281.84 Typical High $407.38 | Facility | 54 · Surgery only | $154.88 | $281.84 | $407.38 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $30.90 Median $56.23 Typical High $81.28 | Facility | 55 · Aftercare only | $30.90 | $56.23 | $81.28 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $20.42 Median $38.02 Typical High $53.70 | Facility | 56 · Pre-op care only | $20.42 | $38.02 | $53.70 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $102.33 Median $102.33 Typical High $288.40 | Professional | 52 · Reduced service | $102.33 | $102.33 | $288.40 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $41.69 Typical High $114.82 | Professional | 53 · Discontinued | $41.69 | $41.69 | $114.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $154.88 Typical High $426.58 | Professional | 54 · Surgery only | $154.88 | $154.88 | $426.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $30.90 Typical High $87.10 | Professional | 55 · Aftercare only | $30.90 | $30.90 | $87.10 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $20.42 Typical High $57.54 | Professional | 56 · Pre-op care only | $20.42 | $20.42 | $57.54 |
Where Ohio sits
The same service costs 25.7 times more in Oklahoma than in Vermont. 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· 33rd of 51
$263
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.