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 $0.40 Median $1.07 Typical High $2.34 | Facility | None | $0.40 | $1.07 | $2.34 |
Aetna Setting Professional Modifier None Typical Low $0.39 Median $0.42 Typical High $6.03 | Professional | None | $0.39 | $0.42 | $6.03 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.52 Median $1.12 Typical High $3.09 | Facility | None | $0.52 | $1.12 | $3.09 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.39 Median $0.39 Typical High $0.81 | Professional | None | $0.39 | $0.39 | $0.81 |
Aultcare Setting Facility Modifier None Typical Low $0.52 Median $0.52 Typical High $0.52 | Facility | None | $0.52 | $0.52 | $0.52 |
CareSource Setting Facility Modifier None Typical Low $0.56 Median $0.56 Typical High $0.56 | Facility | None | $0.56 | $0.56 | $0.56 |
CareSource Setting Professional Modifier None Typical Low $0.76 Median $0.76 Typical High $0.76 | Professional | None | $0.76 | $0.76 | $0.76 |
Cigna Setting Facility Modifier None Typical Low $0.74 Median $0.83 Typical High $1.29 | Facility | None | $0.74 | $0.83 | $1.29 |
Cigna Setting Professional Modifier None Typical Low $0.39 Median $0.39 Typical High $2.40 | Professional | None | $0.39 | $0.39 | $2.40 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $0.79 Median $0.98 Typical High $3.02 | Facility | None | $0.79 | $0.98 | $3.02 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.39 Median $0.39 Typical High $2.40 | Professional | None | $0.39 | $0.39 | $2.40 |
Molina Setting Professional Modifier None Typical Low $0.49 Median $0.60 Typical High $0.74 | Professional | None | $0.49 | $0.60 | $0.74 |
SummaCare Setting Professional Modifier None Typical Low $0.39 Median $0.43 Typical High $0.78 | Professional | None | $0.39 | $0.43 | $0.78 |
United Setting Professional Modifier None Typical Low $0.48 Median $0.48 Typical High $0.71 | Professional | None | $0.48 | $0.48 | $0.71 |
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 $0.20 Median $0.20 Typical High $3.02 | Professional | 52 · Reduced service | $0.20 | $0.20 | $3.02 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.08 Median $0.08 Typical High $1.20 | Professional | 53 · Discontinued | $0.08 | $0.08 | $1.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.06 Median $0.06 Typical High $0.89 | Professional | 55 · Aftercare only | $0.06 | $0.06 | $0.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.60 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $0.60 |
Where Ohio sits
The same service costs 5.2 times more in Wyoming than in Georgia. 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· 31st of 51
$0.48
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.