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 $10.23 Median $10.23 Typical High $74.13 | Facility | None | $10.23 | $10.23 | $74.13 |
Aetna Setting Professional Modifier None Typical Low $10.23 Median $10.23 Typical High $33.11 | Professional | None | $10.23 | $10.23 | $33.11 |
Anthem BCBS Setting Professional Modifier None Typical Low $4.79 Median $6.61 Typical High $16.60 | Professional | None | $4.79 | $6.61 | $16.60 |
CareSource Setting Facility Modifier None Typical Low $20.89 Median $20.89 Typical High $20.89 | Facility | None | $20.89 | $20.89 | $20.89 |
CareSource Setting Professional Modifier None Typical Low $20.89 Median $20.89 Typical High $21.88 | Professional | None | $20.89 | $20.89 | $21.88 |
Cigna Setting Professional Modifier None Typical Low $6.76 Median $6.76 Typical High $6.76 | Professional | None | $6.76 | $6.76 | $6.76 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $6.76 Median $6.76 Typical High $6.76 | Professional | None | $6.76 | $6.76 | $6.76 |
Molina Setting Professional Modifier None Typical Low $3.80 Median $5.25 Typical High $10.47 | Professional | None | $3.80 | $5.25 | $10.47 |
SummaCare Setting Professional Modifier None Typical Low $14.13 Median $17.38 Typical High $22.39 | Professional | None | $14.13 | $17.38 | $22.39 |
United Setting Professional Modifier None Typical Low $5.37 Median $7.94 Typical High $10.23 | Professional | None | $5.37 | $7.94 | $10.23 |
5 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 $5.13 Median $5.13 Typical High $16.60 | Professional | 52 · Reduced service | $5.13 | $5.13 | $16.60 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.04 Median $2.04 Typical High $6.61 | Professional | 53 · Discontinued | $2.04 | $2.04 | $6.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $7.76 Median $7.76 Typical High $24.55 | Professional | 54 · Surgery only | $7.76 | $7.76 | $24.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.55 Median $1.55 Typical High $4.90 | Professional | 55 · Aftercare only | $1.55 | $1.55 | $4.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.02 Median $1.02 Typical High $3.31 | Professional | 56 · Pre-op care only | $1.02 | $1.02 | $3.31 |
Where Ohio sits
The same service costs 3.2 times more in Rhode Island 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· 50th of 51
$6.76
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.