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 $0.41 Median $1.23 Typical High $3.31 | Facility | None | $0.41 | $1.23 | $3.31 |
Aetna Setting Professional Modifier None Typical Low $0.37 Median $0.42 Typical High $3.02 | Professional | None | $0.37 | $0.42 | $3.02 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.25 Median $0.40 Typical High $0.87 | Facility | None | $0.25 | $0.40 | $0.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.31 Median $0.37 Typical High $0.78 | Professional | None | $0.31 | $0.37 | $0.78 |
CareSource Setting Facility Modifier None Typical Low $0.32 Median $0.32 Typical High $0.32 | Facility | None | $0.32 | $0.32 | $0.32 |
CareSource Setting Professional Modifier None Typical Low $0.43 Median $0.43 Typical High $0.43 | Professional | None | $0.43 | $0.43 | $0.43 |
Cigna Setting Facility Modifier None Typical Low $0.71 Median $0.79 Typical High $1.23 | Facility | None | $0.71 | $0.79 | $1.23 |
Cigna Setting Professional Modifier None Typical Low $0.37 Median $0.37 Typical High $1.74 | Professional | None | $0.37 | $0.37 | $1.74 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $0.44 Median $0.93 Typical High $3.31 | Facility | None | $0.44 | $0.93 | $3.31 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.37 Median $0.37 Typical High $1.74 | Professional | None | $0.37 | $0.37 | $1.74 |
Molina Setting Professional Modifier None Typical Low $0.29 Median $0.45 Typical High $0.52 | Professional | None | $0.29 | $0.45 | $0.52 |
SummaCare Setting Professional Modifier None Typical Low $0.39 Median $0.41 Typical High $0.74 | Professional | None | $0.39 | $0.41 | $0.74 |
United Setting Facility Modifier None Typical Low $0.37 Median $0.37 Typical High $0.37 | Facility | None | $0.37 | $0.37 | $0.37 |
United Setting Professional Modifier None Typical Low $0.23 Median $0.23 Typical High $0.34 | Professional | None | $0.23 | $0.23 | $0.34 |
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 $0.19 Median $0.19 Typical High $1.51 | Professional | 52 · Reduced service | $0.19 | $0.19 | $1.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.07 Median $0.07 Typical High $0.60 | Professional | 53 · Discontinued | $0.07 | $0.07 | $0.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.06 Median $0.06 Typical High $0.45 | Professional | 55 · Aftercare only | $0.06 | $0.06 | $0.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.30 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $0.30 |
Where Ohio sits
The same service costs 7.8 times more in Texas than in Maryland. 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· 24th of 51
$0.37
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.