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 $173.78 Median $380.19 Typical High $588.84 | Facility | None | $173.78 | $380.19 | $588.84 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $199.53 | Professional | None | $173.78 | $173.78 | $199.53 |
Anthem BCBS Setting Facility Modifier None Typical Low $177.83 Median $263.03 Typical High $512.86 | Facility | None | $177.83 | $263.03 | $512.86 |
Anthem BCBS Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $239.88 | Professional | None | $173.78 | $173.78 | $239.88 |
CareSource Setting Facility Modifier None Typical Low $165.96 Median $165.96 Typical High $165.96 | Facility | None | $165.96 | $165.96 | $165.96 |
CareSource Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $223.87 | Professional | None | $165.96 | $165.96 | $223.87 |
Cigna Setting Facility Modifier None Typical Low $162.18 Median $371.54 Typical High $575.44 | Facility | None | $162.18 | $371.54 | $575.44 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | None | $173.78 | $173.78 | $173.78 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $162.18 Median $371.54 Typical High $524.81 | Facility | None | $162.18 | $371.54 | $524.81 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $181.97 | Professional | None | $173.78 | $173.78 | $181.97 |
Molina Setting Professional Modifier None Typical Low $162.18 Median $181.97 Typical High $213.80 | Professional | None | $162.18 | $181.97 | $213.80 |
SummaCare Setting Professional Modifier None Typical Low $173.78 Median $181.97 Typical High $213.80 | Professional | None | $173.78 | $181.97 | $213.80 |
United Setting Facility Modifier None Typical Low $173.78 Median $173.78 Typical High $173.78 | Facility | None | $173.78 | $173.78 | $173.78 |
United Setting Professional Modifier None Typical Low $151.36 Median $169.82 Typical High $186.21 | Professional | None | $151.36 | $169.82 | $186.21 |
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 $87.10 Median $87.10 Typical High $95.50 | Professional | 52 · Reduced service | $87.10 | $87.10 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $34.67 Typical High $38.02 | Professional | 53 · Discontinued | $34.67 | $34.67 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $128.82 Typical High $141.25 | Professional | 54 · Surgery only | $128.82 | $128.82 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $25.70 Typical High $28.84 | Professional | 55 · Aftercare only | $25.70 | $25.70 | $28.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $17.38 Typical High $19.05 | Professional | 56 · Pre-op care only | $17.38 | $17.38 | $19.05 |
Where Ohio sits
Rates are fairly even across states for this service. 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· 47th of 51
$174
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.