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 $15.14 Median $15.14 Typical High $64.57 | Facility | None | $15.14 | $15.14 | $64.57 |
Aetna Setting Professional Modifier None Typical Low $15.14 Median $15.14 Typical High $38.02 | Professional | None | $15.14 | $15.14 | $38.02 |
Anthem BCBS Setting Professional Modifier None Typical Low $7.08 Median $9.77 Typical High $23.99 | Professional | None | $7.08 | $9.77 | $23.99 |
CareSource Setting Facility Modifier None Typical Low $30.90 Median $30.90 Typical High $30.90 | Facility | None | $30.90 | $30.90 | $30.90 |
CareSource Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $31.62 | Professional | None | $30.90 | $30.90 | $31.62 |
Cigna Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $9.77 | Professional | None | $9.77 | $9.77 | $9.77 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $9.77 | Professional | None | $9.77 | $9.77 | $9.77 |
Molina Setting Professional Modifier None Typical Low $5.62 Median $7.76 Typical High $15.14 | Professional | None | $5.62 | $7.76 | $15.14 |
SummaCare Setting Professional Modifier None Typical Low $20.42 Median $25.12 Typical High $33.11 | Professional | None | $20.42 | $25.12 | $33.11 |
United Setting Professional Modifier None Typical Low $7.94 Median $11.75 Typical High $14.79 | Professional | None | $7.94 | $11.75 | $14.79 |
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 $7.59 Median $7.59 Typical High $19.05 | Professional | 52 · Reduced service | $7.59 | $7.59 | $19.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.02 Median $3.02 Typical High $7.59 | Professional | 53 · Discontinued | $3.02 | $3.02 | $7.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $11.22 Median $11.22 Typical High $28.84 | Professional | 54 · Surgery only | $11.22 | $11.22 | $28.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.24 Median $2.24 Typical High $5.75 | Professional | 55 · Aftercare only | $2.24 | $2.24 | $5.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.51 Median $1.51 Typical High $3.80 | Professional | 56 · Pre-op care only | $1.51 | $1.51 | $3.80 |
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
$9.77
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.