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 $2.75 Median $3.72 Typical High $5.13 | Facility | None | $2.75 | $3.72 | $5.13 |
Aetna Setting Professional Modifier None Typical Low $2.45 Median $2.75 Typical High $3.02 | Professional | None | $2.45 | $2.75 | $3.02 |
Ambetter Setting Professional Modifier None Typical Low $2.82 Median $2.82 Typical High $2.82 | Professional | None | $2.82 | $2.82 | $2.82 |
Anthem BCBS Setting Professional Modifier None Typical Low $1.35 Median $1.51 Typical High $3.24 | Professional | None | $1.35 | $1.51 | $3.24 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $1.41 Median $1.58 Typical High $2.04 | Professional | UE · Used equipment | $1.41 | $1.58 | $2.04 |
CareSource Setting Facility Modifier None Typical Low $4.79 Median $4.79 Typical High $4.79 | Facility | None | $4.79 | $4.79 | $4.79 |
CareSource Setting Professional Modifier None Typical Low $3.72 Median $5.01 Typical High $5.25 | Professional | None | $3.72 | $5.01 | $5.25 |
Cigna Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | None | $2.24 | $2.24 | $2.24 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $2.34 Median $8.91 Typical High $38.02 | Facility | None | $2.34 | $8.91 | $38.02 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | None | $2.24 | $2.24 | $2.24 |
Molina Setting Professional Modifier None Typical Low $2.51 Median $3.47 Typical High $5.13 | Professional | None | $2.51 | $3.47 | $5.13 |
SummaCare Setting Professional Modifier None Typical Low $4.27 Median $4.47 Typical High $6.17 | Professional | None | $4.27 | $4.47 | $6.17 |
United Setting Professional Modifier None Typical Low $1.45 Median $2.19 Typical High $2.63 | Professional | None | $1.45 | $2.19 | $2.63 |
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 $1.38 Median $1.38 Typical High $1.58 | Professional | 52 · Reduced service | $1.38 | $1.38 | $1.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.56 Median $0.56 Typical High $0.65 | Professional | 53 · Discontinued | $0.56 | $0.56 | $0.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.42 Median $0.42 Typical High $0.48 | Professional | 55 · Aftercare only | $0.42 | $0.42 | $0.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.28 Median $0.28 Typical High $0.32 | Professional | 56 · Pre-op care only | $0.28 | $0.28 | $0.32 |
Aetna Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $1.20 Median $1.20 Typical High $1.20 | Professional | AU · Urologic/ostomy supply | $1.20 | $1.20 | $1.20 |
Anthem BCBS Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $4.47 Median $6.17 Typical High $7.41 | Professional | AU · Urologic/ostomy supply | $4.47 | $6.17 | $7.41 |
SummaCare Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $3.80 Median $4.47 Typical High $6.17 | Professional | AU · Urologic/ostomy supply | $3.80 | $4.47 | $6.17 |
Where Ohio sits
The same service costs 4.4 times more in Minnesota than in New Hampshire. 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· 26th of 51
$2.24
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.