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 $40.74 Median $40.74 Typical High $77.62 | Facility | None | $40.74 | $40.74 | $77.62 |
Aetna Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $77.62 | Professional | None | $40.74 | $40.74 | $77.62 |
Ambetter Setting Professional Modifier None Typical Low $38.02 Median $39.81 Typical High $44.67 | Professional | None | $38.02 | $39.81 | $44.67 |
Anthem BCBS Setting Professional Modifier None Typical Low $28.18 Median $35.48 Typical High $61.66 | Professional | None | $28.18 | $35.48 | $61.66 |
CareSource Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $56.23 | Professional | None | $56.23 | $56.23 | $56.23 |
Cigna Setting Professional Modifier None Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | None | $7.59 | $7.59 | $7.59 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $7.59 Median $7.59 Typical High $14.79 | Professional | None | $7.59 | $7.59 | $14.79 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $41.69 | Professional | None | $33.11 | $33.11 | $41.69 |
SummaCare Setting Professional Modifier None Typical Low $44.67 Median $44.67 Typical High $89.13 | Professional | None | $44.67 | $44.67 | $89.13 |
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 $20.42 Median $20.42 Typical High $38.90 | Professional | 52 · Reduced service | $20.42 | $20.42 | $38.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.13 Median $8.13 Typical High $15.49 | Professional | 53 · Discontinued | $8.13 | $8.13 | $15.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.17 Median $6.17 Typical High $11.48 | Professional | 55 · Aftercare only | $6.17 | $6.17 | $11.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.07 Median $4.07 Typical High $7.76 | Professional | 56 · Pre-op care only | $4.07 | $4.07 | $7.76 |
Where Ohio sits
The same service costs 204.2 times more in Montana than in Kansas. 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· 41st of 51
$35.48
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.