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 $57.54 Median $85.11 Typical High $275.42 | Facility | None | $57.54 | $85.11 | $275.42 |
Aetna Setting Professional Modifier None Typical Low $57.54 Median $85.11 Typical High $154.88 | Professional | None | $57.54 | $85.11 | $154.88 |
Ambetter Setting Professional Modifier None Typical Low $69.18 Median $107.15 Typical High $151.36 | Professional | None | $69.18 | $107.15 | $151.36 |
Anthem BCBS Setting Professional Modifier None Typical Low $93.33 Median $120.23 Typical High $151.36 | Professional | None | $93.33 | $120.23 | $151.36 |
Aultcare Setting Professional Modifier None Typical Low $107.15 Median $120.23 Typical High $186.21 | Professional | None | $107.15 | $120.23 | $186.21 |
CareSource Setting Facility Modifier None Typical Low $69.18 Median $107.15 Typical High $138.04 | Facility | None | $69.18 | $107.15 | $138.04 |
CareSource Setting Professional Modifier None Typical Low $100.00 Median $107.15 Typical High $158.49 | Professional | None | $100.00 | $107.15 | $158.49 |
Cigna Setting Professional Modifier None Typical Low $70.79 Median $97.72 Typical High $141.25 | Professional | None | $70.79 | $97.72 | $141.25 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $72.44 Median $100.00 Typical High $208.93 | Professional | None | $72.44 | $100.00 | $208.93 |
Molina Setting Professional Modifier None Typical Low $38.90 Median $79.43 Typical High $151.36 | Professional | None | $38.90 | $79.43 | $151.36 |
SummaCare Setting Professional Modifier None Typical Low $64.57 Median $87.10 Typical High $114.82 | Professional | None | $64.57 | $87.10 | $114.82 |
United Setting Professional Modifier None Typical Low $57.54 Median $85.11 Typical High $125.89 | Professional | None | $57.54 | $85.11 | $125.89 |
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 Professional Modifier 52 · Reduced service Typical Low $28.84 Median $41.69 Typical High $47.86 | Professional | 52 · Reduced service | $28.84 | $41.69 | $47.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $12.59 Typical High $14.45 | Professional | 55 · Aftercare only | $8.51 | $12.59 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $8.51 Typical High $9.55 | Professional | 56 · Pre-op care only | $5.75 | $8.51 | $9.55 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $91.20 Median $107.15 Typical High $107.15 | Professional | 25 · Same-day visit | $91.20 | $107.15 | $107.15 |
Ambetter Setting Professional Modifier EP · Child screening program Typical Low $107.15 Median $107.15 Typical High $107.15 | Professional | EP · Child screening program | $107.15 | $107.15 | $107.15 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $165.96 Median $165.96 Typical High $165.96 | Professional | GC · Resident with teaching physician | $165.96 | $165.96 | $165.96 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $70.79 Median $70.79 Typical High $70.79 | Professional | SA · Nurse practitioner | $70.79 | $70.79 | $70.79 |
Where Ohio sits
The same service costs 2.9 times more in Alaska than in Washington, DC. 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· 30th 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.