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 $0.08 Median $0.08 Typical High $12.88 | Facility | None | $0.08 | $0.08 | $12.88 |
Aetna Setting Professional Modifier None Typical Low $0.08 Median $0.08 Typical High $0.09 | Professional | None | $0.08 | $0.08 | $0.09 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.04 Median $0.04 Typical High $0.05 | Professional | 52 · Reduced service | $0.04 | $0.04 | $0.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.02 Median $0.02 Typical High $0.02 | Professional | 53 · Discontinued | $0.02 | $0.02 | $0.02 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.09 Median $0.19 Typical High $0.52 | Facility | None | $0.09 | $0.19 | $0.52 |
Anthem BCBS Setting Professional Modifier None Typical Low $0.04 Median $0.04 Typical High $0.08 | Professional | None | $0.04 | $0.04 | $0.08 |
CareSource Setting Professional Modifier None Typical Low $0.09 Median $0.09 Typical High $0.09 | Professional | None | $0.09 | $0.09 | $0.09 |
Cigna Setting Facility Modifier None Typical Low $0.19 Median $0.19 Typical High $0.26 | Facility | None | $0.19 | $0.19 | $0.26 |
Cigna Setting Professional Modifier None Typical Low $0.09 Median $0.09 Typical High $0.09 | Professional | None | $0.09 | $0.09 | $0.09 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $0.19 Median $0.19 Typical High $1.17 | Facility | None | $0.19 | $0.19 | $1.17 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $0.09 Median $0.09 Typical High $0.09 | Professional | None | $0.09 | $0.09 | $0.09 |
SummaCare Setting Professional Modifier None Typical Low $0.08 Median $0.08 Typical High $0.10 | Professional | None | $0.08 | $0.08 | $0.10 |
United Setting Professional Modifier None Typical Low $0.07 Median $0.08 Typical High $0.09 | Professional | None | $0.07 | $0.08 | $0.09 |
2 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 55 · Aftercare only Typical Low $1.20 Median $1.51 Typical High $1.95 | Professional | 55 · Aftercare only | $1.20 | $1.51 | $1.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.89 Median $1.00 Typical High $1.29 | Professional | 56 · Pre-op care only | $0.89 | $1.00 | $1.29 |
Where Ohio sits
The same service costs 14.8 times more in Montana than in Hawaii. 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· 38th of 51
$0.08
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.