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 $0.60 Median $0.60 Typical High $2.00 | Facility | None | $0.60 | $0.60 | $2.00 |
Aetna Setting Professional Modifier None Typical Low $0.60 Median $0.60 Typical High $0.83 | Professional | None | $0.60 | $0.60 | $0.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.47 Median $1.20 Typical High $1.58 | Professional | None | $0.47 | $1.20 | $1.58 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.32 Median $0.38 Typical High $0.52 | Professional | UE · Used equipment | $0.32 | $0.38 | $0.52 |
CareSource Setting Facility Modifier None Typical Low $1.23 Median $1.23 Typical High $1.23 | Facility | None | $1.23 | $1.23 | $1.23 |
CareSource Setting Professional Modifier None Typical Low $1.23 Median $1.23 Typical High $1.29 | Professional | None | $1.23 | $1.23 | $1.29 |
Cigna Setting Professional Modifier None Typical Low $0.49 Median $0.49 Typical High $0.49 | Professional | None | $0.49 | $0.49 | $0.49 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.49 Median $0.49 Typical High $0.49 | Professional | None | $0.49 | $0.49 | $0.49 |
Molina Setting Professional Modifier None Typical Low $0.43 Median $0.59 Typical High $0.89 | Professional | None | $0.43 | $0.59 | $0.89 |
SummaCare Setting Professional Modifier None Typical Low $0.81 Median $0.98 Typical High $1.32 | Professional | None | $0.81 | $0.98 | $1.32 |
United Setting Professional Modifier None Typical Low $0.32 Median $0.47 Typical High $0.56 | Professional | None | $0.32 | $0.47 | $0.56 |
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 $0.30 Median $0.30 Typical High $0.42 | Professional | 52 · Reduced service | $0.30 | $0.30 | $0.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.12 Median $0.12 Typical High $0.17 | Professional | 53 · Discontinued | $0.12 | $0.12 | $0.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.09 Median $0.09 Typical High $0.13 | Professional | 55 · Aftercare only | $0.09 | $0.09 | $0.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.06 Median $0.06 Typical High $0.08 | Professional | 56 · Pre-op care only | $0.06 | $0.06 | $0.08 |
Where Ohio sits
The same service costs 2.6 times more in Hawaii than in Colorado. 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
$0.52
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.