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 $74.13 Median $100.00 Typical High $204.17 | Facility | None | $74.13 | $100.00 | $204.17 |
Aetna Setting Professional Modifier None Typical Low $74.13 Median $97.72 Typical High $204.17 | Professional | None | $74.13 | $97.72 | $204.17 |
Ambetter Setting Professional Modifier None Typical Low $109.65 Median $109.65 Typical High $134.90 | Professional | None | $109.65 | $109.65 | $134.90 |
Anthem BCBS Setting Professional Modifier None Typical Low $85.11 Median $107.15 Typical High $295.12 | Professional | None | $85.11 | $107.15 | $295.12 |
CareSource Setting Facility Modifier None Typical Low $120.23 Median $120.23 Typical High $120.23 | Facility | None | $120.23 | $120.23 | $120.23 |
Cigna Setting Professional Modifier None Typical Low $109.65 Median $117.49 Typical High $208.93 | Professional | None | $109.65 | $117.49 | $208.93 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $109.65 Median $117.49 Typical High $181.97 | Professional | None | $109.65 | $117.49 | $181.97 |
Molina Setting Professional Modifier None Typical Low $75.86 Median $85.11 Typical High $109.65 | Professional | None | $75.86 | $85.11 | $109.65 |
SummaCare Setting Professional Modifier None Typical Low $134.90 Median $134.90 Typical High $134.90 | Professional | None | $134.90 | $134.90 | $134.90 |
United Setting Professional Modifier None Typical Low $85.11 Median $123.03 Typical High $204.17 | Professional | None | $85.11 | $123.03 | $204.17 |
7 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 $48.98 Median $48.98 Typical High $102.33 | Facility | 52 · Reduced service | $48.98 | $48.98 | $102.33 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $14.79 Median $14.79 Typical High $30.90 | Facility | 55 · Aftercare only | $14.79 | $14.79 | $30.90 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $10.00 Median $10.00 Typical High $20.42 | Facility | 56 · Pre-op care only | $10.00 | $10.00 | $20.42 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $48.98 Median $48.98 Typical High $134.90 | Professional | 52 · Reduced service | $48.98 | $48.98 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $14.79 Typical High $40.74 | Professional | 55 · Aftercare only | $14.79 | $14.79 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $10.00 Typical High $26.92 | Professional | 56 · Pre-op care only | $10.00 | $10.00 | $26.92 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | 25 · Same-day visit | $109.65 | $109.65 | $109.65 |
Where Ohio sits
The same service costs 2.1 times more in Wisconsin than in Ohio. 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· 51st of 51
$100
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.