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 $1.02 Median $1.02 Typical High $1.02 | Facility | None | $1.02 | $1.02 | $1.02 |
Aetna Setting Professional Modifier None Typical Low $1.02 Median $1.02 Typical High $1.07 | Professional | None | $1.02 | $1.02 | $1.07 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.52 Median $0.66 Typical High $0.93 | Professional | None | $0.52 | $0.66 | $0.93 |
Cigna Setting Facility Modifier None Typical Low $1.41 Median $1.41 Typical High $1.86 | Facility | None | $1.41 | $1.41 | $1.86 |
Cigna Setting Professional Modifier None Typical Low $0.65 Median $0.65 Typical High $1.29 | Professional | None | $0.65 | $0.65 | $1.29 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $1.41 Median $1.41 Typical High $1.86 | Facility | None | $1.41 | $1.41 | $1.86 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.65 Median $0.65 Typical High $1.29 | Professional | None | $0.65 | $0.65 | $1.29 |
United Setting Professional Modifier None Typical Low $0.36 Median $0.36 Typical High $0.52 | Professional | None | $0.36 | $0.36 | $0.52 |
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 $0.52 Median $0.52 Typical High $0.52 | Professional | 52 · Reduced service | $0.52 | $0.52 | $0.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.21 Median $0.21 Typical High $4.57 | Professional | 53 · Discontinued | $0.21 | $0.21 | $4.57 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.15 Median $0.15 Typical High $3.47 | Professional | 55 · Aftercare only | $0.15 | $0.15 | $3.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.10 Median $0.10 Typical High $2.29 | Professional | 56 · Pre-op care only | $0.10 | $0.10 | $2.29 |
Where Ohio sits
The same service costs 27.5 times more in Kansas 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· 22nd of 51
$0.66
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.