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 $4.57 Median $4.57 Typical High $37.15 | Facility | None | $4.57 | $4.57 | $37.15 |
Aetna Setting Professional Modifier None Typical Low $4.57 Median $4.57 Typical High $7.94 | Professional | None | $4.57 | $4.57 | $7.94 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.14 Median $2.95 Typical High $7.41 | Professional | None | $2.14 | $2.95 | $7.41 |
CareSource Setting Facility Modifier None Typical Low $9.33 Median $9.33 Typical High $9.33 | Facility | None | $9.33 | $9.33 | $9.33 |
CareSource Setting Professional Modifier None Typical Low $9.33 Median $9.33 Typical High $9.77 | Professional | None | $9.33 | $9.33 | $9.77 |
Cigna Setting Professional Modifier None Typical Low $3.02 Median $3.02 Typical High $3.02 | Professional | None | $3.02 | $3.02 | $3.02 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $3.02 Median $3.02 Typical High $3.02 | Professional | None | $3.02 | $3.02 | $3.02 |
Molina Setting Professional Modifier None Typical Low $1.74 Median $2.34 Typical High $4.57 | Professional | None | $1.74 | $2.34 | $4.57 |
SummaCare Setting Professional Modifier None Typical Low $6.31 Median $7.76 Typical High $10.00 | Professional | None | $6.31 | $7.76 | $10.00 |
United Setting Professional Modifier None Typical Low $2.40 Median $3.55 Typical High $4.57 | Professional | None | $2.40 | $3.55 | $4.57 |
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 $2.29 Median $2.29 Typical High $4.79 | Professional | 52 · Reduced service | $2.29 | $2.29 | $4.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.91 Median $0.91 Typical High $1.91 | Professional | 53 · Discontinued | $0.91 | $0.91 | $1.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.47 Median $3.47 Typical High $5.89 | Professional | 54 · Surgery only | $3.47 | $3.47 | $5.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.69 Median $0.69 Typical High $1.45 | Professional | 55 · Aftercare only | $0.69 | $0.69 | $1.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.46 Median $0.46 Typical High $0.95 | Professional | 56 · Pre-op care only | $0.46 | $0.46 | $0.95 |
Where Ohio sits
The same service costs 2.7 times more in Hawaii 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
$3.02
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.