How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $5.01 Median $87.10 Typical High $144.54 | Facility | None | $5.01 | $87.10 | $144.54 |
Aetna Setting Professional Modifier None Typical Low $5.01 Median $5.01 Typical High $26.92 | Professional | None | $5.01 | $5.01 | $26.92 |
Anthem BCBS Setting Professional Modifier None Typical Low $32.36 Median $33.11 Typical High $47.86 | Professional | None | $32.36 | $33.11 | $47.86 |
CareSource Setting Facility Modifier None Typical Low $20.42 Median $20.42 Typical High $20.42 | Facility | None | $20.42 | $20.42 | $20.42 |
CareSource Setting Professional Modifier None Typical Low $6.61 Median $20.42 Typical High $147.91 | Professional | None | $6.61 | $20.42 | $147.91 |
Cigna Setting Professional Modifier None Typical Low $19.05 Median $24.55 Typical High $28.18 | Professional | None | $19.05 | $24.55 | $28.18 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $19.05 Median $22.91 Typical High $26.92 | Professional | None | $19.05 | $22.91 | $26.92 |
Molina Setting Professional Modifier None Typical Low $50.12 Median $50.12 Typical High $60.26 | Professional | None | $50.12 | $50.12 | $60.26 |
Optum Setting Professional Modifier None Typical Low $23.99 Median $23.99 Typical High $23.99 | Professional | None | $23.99 | $23.99 | $23.99 |
SummaCare Setting Professional Modifier None Typical Low $50.12 Median $60.26 Typical High $70.79 | Professional | None | $50.12 | $60.26 | $70.79 |
United Setting Facility Modifier None Typical Low $77.62 Median $89.13 Typical High $128.82 | Facility | None | $77.62 | $89.13 | $128.82 |
United Setting Professional Modifier None Typical Low $12.02 Median $23.99 Typical High $23.99 | Professional | None | $12.02 | $23.99 | $23.99 |
4 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 $2.51 Median $2.51 Typical High $13.49 | Professional | 52 · Reduced service | $2.51 | $2.51 | $13.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.00 Median $1.00 Typical High $5.50 | Professional | 53 · Discontinued | $1.00 | $1.00 | $5.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.76 Median $0.76 Typical High $4.07 | Professional | 55 · Aftercare only | $0.76 | $0.76 | $4.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.50 Median $0.50 Typical High $2.69 | Professional | 56 · Pre-op care only | $0.50 | $0.50 | $2.69 |
Where Ohio sits
The same service costs 11.7 times more in New York than in North Carolina. 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· 7th of 51
$32.36
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.