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 $0.56 Median $0.56 Typical High $2.00 | Facility | None | $0.56 | $0.56 | $2.00 |
Aetna Setting Professional Modifier None Typical Low $0.56 Median $0.56 Typical High $0.78 | Professional | None | $0.56 | $0.56 | $0.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.41 Median $1.12 Typical High $1.48 | Professional | None | $0.41 | $1.12 | $1.48 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $0.28 Median $0.34 Typical High $0.47 | Professional | UE · Used equipment | $0.28 | $0.34 | $0.47 |
CareSource Setting Facility Modifier None Typical Low $1.12 Median $1.12 Typical High $1.12 | Facility | None | $1.12 | $1.12 | $1.12 |
CareSource Setting Professional Modifier None Typical Low $1.12 Median $1.12 Typical High $1.20 | Professional | None | $1.12 | $1.12 | $1.20 |
Cigna Setting Professional Modifier None Typical Low $0.45 Median $0.45 Typical High $0.45 | Professional | None | $0.45 | $0.45 | $0.45 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.45 Median $0.45 Typical High $0.45 | Professional | None | $0.45 | $0.45 | $0.45 |
Molina Setting Professional Modifier None Typical Low $0.44 Median $0.62 Typical High $0.91 | Professional | None | $0.44 | $0.62 | $0.91 |
SummaCare Setting Professional Modifier None Typical Low $0.78 Median $0.89 Typical High $1.23 | Professional | None | $0.78 | $0.89 | $1.23 |
United Setting Professional Modifier None Typical Low $0.28 Median $0.43 Typical High $0.52 | Professional | None | $0.28 | $0.43 | $0.52 |
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 $0.28 Median $0.28 Typical High $0.38 | Professional | 52 · Reduced service | $0.28 | $0.28 | $0.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.11 Median $0.11 Typical High $0.15 | Professional | 53 · Discontinued | $0.11 | $0.11 | $0.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.08 Median $0.08 Typical High $0.11 | Professional | 55 · Aftercare only | $0.08 | $0.08 | $0.11 |
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 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· 36th of 51
$0.45
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.