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 $5.01 Median $64.57 Typical High $64.57 | Facility | None | $5.01 | $64.57 | $64.57 |
Aetna Setting Professional Modifier None Typical Low $5.01 Median $64.57 Typical High $64.57 | Professional | None | $5.01 | $64.57 | $64.57 |
Anthem BCBS Setting Professional Modifier None Typical Low $57.54 Median $70.79 Typical High $102.33 | Professional | None | $57.54 | $70.79 | $102.33 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $72.44 Median $72.44 Typical High $72.44 | Professional | None | $72.44 | $72.44 | $72.44 |
Molina Setting Professional Modifier None Typical Low $39.81 Median $50.12 Typical High $50.12 | Professional | None | $39.81 | $50.12 | $50.12 |
United Setting Professional Modifier None Typical Low $81.28 Median $81.28 Typical High $120.23 | Professional | None | $81.28 | $81.28 | $120.23 |
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 $2.51 Median $32.36 Typical High $32.36 | Professional | 52 · Reduced service | $2.51 | $32.36 | $32.36 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.00 Median $12.88 Typical High $12.88 | Professional | 53 · Discontinued | $1.00 | $12.88 | $12.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.76 Median $9.77 Typical High $9.77 | Professional | 55 · Aftercare only | $0.76 | $9.77 | $9.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.50 Median $6.46 Typical High $6.46 | Professional | 56 · Pre-op care only | $0.50 | $6.46 | $6.46 |
Where Ohio sits
The same service costs 1.9 times more in Alabama than in New York. 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· 39th of 51
$70.79
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.