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 $1.26 Median $1.26 Typical High $3.98 | Facility | None | $1.26 | $1.26 | $3.98 |
Aetna Setting Professional Modifier None Typical Low $1.26 Median $1.26 Typical High $3.02 | Professional | None | $1.26 | $1.26 | $3.02 |
Anthem BCBS Setting Facility Modifier None Typical Low $1.38 Median $2.19 Typical High $3.98 | Facility | None | $1.38 | $2.19 | $3.98 |
Anthem BCBS Setting Professional Modifier None Typical Low $1.26 Median $1.26 Typical High $2.29 | Professional | None | $1.26 | $1.26 | $2.29 |
CareSource Setting Facility Modifier None Typical Low $1.10 Median $1.10 Typical High $1.10 | Facility | None | $1.10 | $1.10 | $1.10 |
CareSource Setting Professional Modifier None Typical Low $1.48 Median $1.48 Typical High $1.48 | Professional | None | $1.48 | $1.48 | $1.48 |
Cigna Setting Facility Modifier None Typical Low $2.34 Median $2.69 Typical High $4.17 | Facility | None | $2.34 | $2.69 | $4.17 |
Cigna Setting Professional Modifier None Typical Low $1.26 Median $1.26 Typical High $1.74 | Professional | None | $1.26 | $1.26 | $1.74 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $2.63 Median $2.69 Typical High $3.63 | Facility | None | $2.63 | $2.69 | $3.63 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1.26 Median $1.26 Typical High $1.74 | Professional | None | $1.26 | $1.26 | $1.74 |
Molina Setting Professional Modifier None Typical Low $1.38 Median $1.55 Typical High $1.95 | Professional | None | $1.38 | $1.55 | $1.95 |
SummaCare Setting Professional Modifier None Typical Low $1.32 Median $1.38 Typical High $2.51 | Professional | None | $1.32 | $1.38 | $2.51 |
United Setting Facility Modifier None Typical Low $1.26 Median $1.26 Typical High $1.26 | Facility | None | $1.26 | $1.26 | $1.26 |
United Setting Professional Modifier None Typical Low $1.38 Median $1.38 Typical High $2.04 | Professional | None | $1.38 | $1.38 | $2.04 |
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 $0.63 Median $0.63 Typical High $1.51 | Professional | 52 · Reduced service | $0.63 | $0.63 | $1.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.25 Median $0.25 Typical High $0.60 | Professional | 53 · Discontinued | $0.25 | $0.25 | $0.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.19 Median $0.19 Typical High $0.45 | Professional | 55 · Aftercare only | $0.19 | $0.19 | $0.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.13 Median $0.13 Typical High $0.30 | Professional | 56 · Pre-op care only | $0.13 | $0.13 | $0.30 |
Where Ohio sits
The same service costs 1.7 times more in Arizona than in Oklahoma. 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
$1.51
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.