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 $1.10 Median $2.00 Typical High $2.95 | Facility | None | $1.10 | $2.00 | $2.95 |
Aetna Setting Professional Modifier None Typical Low $1.10 Median $1.10 Typical High $1.10 | Professional | None | $1.10 | $1.10 | $1.10 |
Anthem BCBS Setting Facility Modifier None Typical Low $1.26 Median $2.75 Typical High $7.59 | Facility | None | $1.26 | $2.75 | $7.59 |
Anthem BCBS Setting Professional Modifier None Typical Low $1.10 Median $1.10 Typical High $2.04 | Professional | None | $1.10 | $1.10 | $2.04 |
CareSource Setting Facility Modifier None Typical Low $1.45 Median $1.45 Typical High $1.45 | Facility | None | $1.45 | $1.45 | $1.45 |
CareSource Setting Professional Modifier None Typical Low $1.95 Median $1.95 Typical High $1.95 | Professional | None | $1.95 | $1.95 | $1.95 |
Cigna Setting Facility Modifier None Typical Low $2.09 Median $2.34 Typical High $3.63 | Facility | None | $2.09 | $2.34 | $3.63 |
Cigna Setting Professional Modifier None Typical Low $1.10 Median $1.10 Typical High $2.40 | Professional | None | $1.10 | $1.10 | $2.40 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $2.24 Median $2.34 Typical High $3.16 | Facility | None | $2.24 | $2.34 | $3.16 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1.10 Median $1.10 Typical High $2.40 | Professional | None | $1.10 | $1.10 | $2.40 |
Molina Setting Professional Modifier None Typical Low $1.38 Median $1.91 Typical High $2.69 | Professional | None | $1.38 | $1.91 | $2.69 |
SummaCare Setting Professional Modifier None Typical Low $1.10 Median $1.20 Typical High $2.19 | Professional | None | $1.10 | $1.20 | $2.19 |
United Setting Professional Modifier None Typical Low $1.17 Median $1.17 Typical High $1.74 | Professional | None | $1.17 | $1.17 | $1.74 |
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 $0.55 Median $0.55 Typical High $0.55 | Professional | 52 · Reduced service | $0.55 | $0.55 | $0.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.22 Median $0.22 Typical High $0.22 | Professional | 53 · Discontinued | $0.22 | $0.22 | $0.22 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.17 Median $0.17 Typical High $10.96 | Professional | 55 · Aftercare only | $0.17 | $0.17 | $10.96 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.11 Median $0.11 Typical High $7.59 | Professional | 56 · Pre-op care only | $0.11 | $0.11 | $7.59 |
Where Ohio sits
The same service costs 3.0 times more in Oklahoma than in Delaware. 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· 35th of 51
$1.17
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.