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 $3.63 Median $3.63 Typical High $37.15 | Facility | None | $3.63 | $3.63 | $37.15 |
Aetna Setting Professional Modifier None Typical Low $3.63 Median $3.63 Typical High $8.71 | Professional | None | $3.63 | $3.63 | $8.71 |
Anthem BCBS Setting Professional Modifier None Typical Low $1.70 Median $2.34 Typical High $5.75 | Professional | None | $1.70 | $2.34 | $5.75 |
CareSource Setting Facility Modifier None Typical Low $7.41 Median $7.41 Typical High $7.41 | Facility | None | $7.41 | $7.41 | $7.41 |
CareSource Setting Professional Modifier None Typical Low $7.41 Median $7.41 Typical High $7.76 | Professional | None | $7.41 | $7.41 | $7.76 |
Cigna Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
Molina Setting Professional Modifier None Typical Low $1.35 Median $1.86 Typical High $3.63 | Professional | None | $1.35 | $1.86 | $3.63 |
SummaCare Setting Professional Modifier None Typical Low $4.90 Median $6.03 Typical High $7.94 | Professional | None | $4.90 | $6.03 | $7.94 |
United Setting Professional Modifier None Typical Low $1.91 Median $2.82 Typical High $3.63 | Professional | None | $1.91 | $2.82 | $3.63 |
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 $1.82 Median $1.82 Typical High $3.80 | Professional | 52 · Reduced service | $1.82 | $1.82 | $3.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.72 Median $0.72 Typical High $1.51 | Professional | 53 · Discontinued | $0.72 | $0.72 | $1.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.69 Median $2.69 Typical High $5.62 | Professional | 54 · Surgery only | $2.69 | $2.69 | $5.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.54 Median $0.54 Typical High $1.32 | Professional | 55 · Aftercare only | $0.54 | $0.54 | $1.32 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.36 Median $0.36 Typical High $0.87 | Professional | 56 · Pre-op care only | $0.36 | $0.36 | $0.87 |
Where Ohio sits
The same service costs 3.0 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
$2.34
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.