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 $2.69 Median $2.69 Typical High $28.18 | Facility | None | $2.69 | $2.69 | $28.18 |
Aetna Setting Professional Modifier None Typical Low $2.69 Median $2.69 Typical High $5.01 | Professional | None | $2.69 | $2.69 | $5.01 |
Ambetter Setting Professional Modifier None Typical Low $3.09 Median $3.09 Typical High $3.09 | Professional | None | $3.09 | $3.09 | $3.09 |
Anthem BCBS Setting Professional Modifier None Typical Low $1.26 Median $1.74 Typical High $4.27 | Professional | None | $1.26 | $1.74 | $4.27 |
CareSource Setting Facility Modifier None Typical Low $5.50 Median $5.50 Typical High $5.50 | Facility | None | $5.50 | $5.50 | $5.50 |
CareSource Setting Professional Modifier None Typical Low $5.50 Median $5.50 Typical High $5.75 | Professional | None | $5.50 | $5.50 | $5.75 |
Cigna Setting Professional Modifier None Typical Low $1.78 Median $1.78 Typical High $1.78 | Professional | None | $1.78 | $1.78 | $1.78 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1.78 Median $1.78 Typical High $1.78 | Professional | None | $1.78 | $1.78 | $1.78 |
Molina Setting Professional Modifier None Typical Low $1.00 Median $1.38 Typical High $2.69 | Professional | None | $1.00 | $1.38 | $2.69 |
SummaCare Setting Professional Modifier None Typical Low $3.63 Median $4.57 Typical High $5.89 | Professional | None | $3.63 | $4.57 | $5.89 |
United Setting Professional Modifier None Typical Low $1.41 Median $2.09 Typical High $2.57 | Professional | None | $1.41 | $2.09 | $2.57 |
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 $1.35 Median $1.35 Typical High $2.14 | Professional | 52 · Reduced service | $1.35 | $1.35 | $2.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.54 Median $0.54 Typical High $0.85 | Professional | 53 · Discontinued | $0.54 | $0.54 | $0.85 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.00 Median $2.00 Typical High $3.16 | Professional | 54 · Surgery only | $2.00 | $2.00 | $3.16 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.40 Median $0.40 Typical High $0.63 | Professional | 55 · Aftercare only | $0.40 | $0.40 | $0.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.27 Median $0.27 Typical High $0.42 | Professional | 56 · Pre-op care only | $0.27 | $0.27 | $0.42 |
Where Ohio sits
The same service costs 4.0 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
$1.78
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.