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 $0.37 Median $0.37 Typical High $5.01 | Facility | None | $0.37 | $0.37 | $5.01 |
Aetna Setting Professional Modifier None Typical Low $0.37 Median $0.37 Typical High $3.98 | Professional | None | $0.37 | $0.37 | $3.98 |
Ambetter Setting Professional Modifier None Typical Low $2.82 Median $2.82 Typical High $2.82 | Professional | None | $2.82 | $2.82 | $2.82 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.41 Median $0.89 Typical High $2.45 | Facility | None | $0.41 | $0.89 | $2.45 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.56 Median $1.23 Typical High $1.82 | Professional | None | $0.56 | $1.23 | $1.82 |
Cigna Setting Facility Modifier None Typical Low $0.58 Median $0.58 Typical High $0.78 | Facility | None | $0.58 | $0.58 | $0.78 |
Cigna Setting Professional Modifier None Typical Low $0.27 Median $0.27 Typical High $0.32 | Professional | None | $0.27 | $0.27 | $0.32 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $0.58 Median $0.58 Typical High $0.78 | Facility | None | $0.58 | $0.58 | $0.78 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.27 Median $0.27 Typical High $0.32 | Professional | None | $0.27 | $0.27 | $0.32 |
Molina Setting Professional Modifier None Typical Low $3.98 Median $5.75 Typical High $6.03 | Professional | None | $3.98 | $5.75 | $6.03 |
SummaCare Setting Professional Modifier None Typical Low $0.29 Median $0.32 Typical High $0.58 | Professional | None | $0.29 | $0.32 | $0.58 |
United Setting Professional Modifier None Typical Low $0.38 Median $0.38 Typical High $0.56 | Professional | None | $0.38 | $0.38 | $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 $0.19 Median $0.19 Typical High $2.00 | Professional | 52 · Reduced service | $0.19 | $0.19 | $2.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.07 Median $0.07 Typical High $0.79 | Professional | 53 · Discontinued | $0.07 | $0.07 | $0.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.06 Median $0.06 Typical High $0.60 | Professional | 55 · Aftercare only | $0.06 | $0.06 | $0.60 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.40 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $0.40 |
Where Ohio sits
The same service costs 6.3 times more in Kansas than in Virginia. 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· 5th of 51
$0.89
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.