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 $0.93 Typical High $1.78 | Facility | None | $0.40 | $0.93 | $1.78 |
Aetna Setting Professional Modifier None Typical Low $0.40 Median $0.49 Typical High $1.48 | Professional | None | $0.40 | $0.49 | $1.48 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.46 Median $1.00 Typical High $2.82 | Facility | None | $0.46 | $1.00 | $2.82 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.40 Median $0.40 Typical High $0.83 | Professional | None | $0.40 | $0.40 | $0.83 |
Aultcare Setting Facility Modifier None Typical Low $0.54 Median $0.54 Typical High $0.54 | Facility | None | $0.54 | $0.54 | $0.54 |
CareSource Setting Facility Modifier None Typical Low $0.43 Median $0.43 Typical High $0.43 | Facility | None | $0.43 | $0.43 | $0.43 |
CareSource Setting Professional Modifier None Typical Low $0.58 Median $0.58 Typical High $0.58 | Professional | None | $0.58 | $0.58 | $0.58 |
Cigna Setting Facility Modifier None Typical Low $0.76 Median $0.85 Typical High $1.32 | Facility | None | $0.76 | $0.85 | $1.32 |
Cigna Setting Professional Modifier None Typical Low $0.40 Median $0.40 Typical High $1.41 | Professional | None | $0.40 | $0.40 | $1.41 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $0.68 Median $1.95 Typical High $6.76 | Facility | None | $0.68 | $1.95 | $6.76 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.40 Median $0.40 Typical High $1.41 | Professional | None | $0.40 | $0.40 | $1.41 |
Molina Setting Professional Modifier None Typical Low $0.47 Median $0.56 Typical High $0.65 | Professional | None | $0.47 | $0.56 | $0.65 |
SummaCare Setting Professional Modifier None Typical Low $0.40 Median $0.74 Typical High $0.79 | Professional | None | $0.40 | $0.74 | $0.79 |
United Setting Professional Modifier None Typical Low $0.43 Median $0.43 Typical High $0.65 | Professional | None | $0.43 | $0.43 | $0.65 |
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 $0.20 | Professional | 52 · Reduced service | $0.20 | $0.20 | $0.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.08 Median $0.08 Typical High $7.94 | Professional | 53 · Discontinued | $0.08 | $0.08 | $7.94 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.06 Median $0.06 Typical High $6.03 | Professional | 55 · Aftercare only | $0.06 | $0.06 | $6.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $3.98 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $3.98 |
Where Ohio sits
The same service costs 4.0 times more in Texas 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· 9th of 51
$0.52
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.