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 $0.34 Median $0.34 Typical High $1.00 | Facility | None | $0.34 | $0.34 | $1.00 |
Aetna Setting Professional Modifier None Typical Low $0.34 Median $0.34 Typical High $0.43 | Professional | None | $0.34 | $0.34 | $0.43 |
Ambetter Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $40.74 | Professional | None | $40.74 | $40.74 | $40.74 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.28 Median $0.72 Typical High $0.93 | Professional | None | $0.28 | $0.72 | $0.93 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.21 Median $0.24 Typical High $0.34 | Professional | UE · Used equipment | $0.21 | $0.24 | $0.34 |
CareSource Setting Facility Modifier None Typical Low $0.71 Median $0.71 Typical High $0.71 | Facility | None | $0.71 | $0.71 | $0.71 |
CareSource Setting Professional Modifier None Typical Low $0.54 Median $0.72 Typical High $0.76 | Professional | None | $0.54 | $0.72 | $0.76 |
Cigna Setting Professional Modifier None Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | None | $0.28 | $0.28 | $0.28 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $1.58 Median $1.58 Typical High $1.58 | Facility | None | $1.58 | $1.58 | $1.58 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | None | $0.28 | $0.28 | $0.28 |
Molina Setting Professional Modifier None Typical Low $0.26 Median $0.36 Typical High $0.54 | Professional | None | $0.26 | $0.36 | $0.54 |
SummaCare Setting Professional Modifier None Typical Low $0.47 Median $0.55 Typical High $0.76 | Professional | None | $0.47 | $0.55 | $0.76 |
United Setting Professional Modifier None Typical Low $0.18 Median $0.28 Typical High $0.35 | Professional | None | $0.18 | $0.28 | $0.35 |
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 $0.17 Median $0.17 Typical High $0.22 | Professional | 52 · Reduced service | $0.17 | $0.17 | $0.22 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.07 Median $0.07 Typical High $0.09 | Professional | 53 · Discontinued | $0.07 | $0.07 | $0.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.07 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.03 Typical High $0.04 | Professional | 56 · Pre-op care only | $0.03 | $0.03 | $0.04 |
Where Ohio sits
The same service costs 2.6 times more in Hawaii than in Utah. 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· 29th of 51
$0.33
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.