How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $4.37 Median $4.37 Typical High $4.37 | Facility | None | $4.37 | $4.37 | $4.37 |
Aetna Setting Professional Modifier None Typical Low $4.37 Median $4.37 Typical High $5.25 | Professional | None | $4.37 | $4.37 | $5.25 |
Ambetter Setting Professional Modifier None Typical Low $3.89 Median $4.57 Typical High $7.24 | Professional | None | $3.89 | $4.57 | $7.24 |
Anthem BCBS Setting Professional Modifier None Typical Low $3.24 Median $3.47 Typical High $10.96 | Professional | None | $3.24 | $3.47 | $10.96 |
CareSource Setting Professional Modifier None Typical Low $3.31 Median $5.13 Typical High $6.31 | Professional | None | $3.31 | $5.13 | $6.31 |
Cigna Setting Professional Modifier None Typical Low $3.02 Median $3.98 Typical High $7.94 | Professional | None | $3.02 | $3.98 | $7.94 |
Kaiser Permanente Setting Professional Modifier None Typical Low $5.37 Median $5.89 Typical High $6.17 | Professional | None | $5.37 | $5.89 | $6.17 |
Oscar Health Setting Facility Modifier None Typical Low $63.10 Median $173.78 Typical High $371.54 | Facility | None | $63.10 | $173.78 | $371.54 |
Oscar Health Setting Professional Modifier None Typical Low $4.79 Median $6.46 Typical High $9.55 | Professional | None | $4.79 | $6.46 | $9.55 |
United Setting Professional Modifier None Typical Low $4.57 Median $8.71 Typical High $14.45 | Professional | None | $4.57 | $8.71 | $14.45 |
9 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 $2.19 Median $2.19 Typical High $2.34 | Professional | 52 · Reduced service | $2.19 | $2.19 | $2.34 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.87 Median $0.87 Typical High $0.95 | Professional | 53 · Discontinued | $0.87 | $0.87 | $0.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.66 Median $0.66 Typical High $0.71 | Professional | 55 · Aftercare only | $0.66 | $0.66 | $0.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.44 Median $0.44 Typical High $0.47 | Professional | 56 · Pre-op care only | $0.44 | $0.44 | $0.47 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $3.89 Median $4.57 Typical High $5.62 | Professional | 59 · Distinct service | $3.89 | $4.57 | $5.62 |
Ambetter Setting Professional Modifier EP · Child screening program Typical Low $4.57 Median $4.57 Typical High $6.31 | Professional | EP · Child screening program | $4.57 | $4.57 | $6.31 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $9.77 Median $9.77 Typical High $9.77 | Professional | Q6 · Substitute physician, paid per time | $9.77 | $9.77 | $9.77 |
Ambetter Setting Professional Modifier XU · Unusual separate service Typical Low $7.24 Median $7.24 Typical High $7.24 | Professional | XU · Unusual separate service | $7.24 | $7.24 | $7.24 |
Anthem BCBS Setting Professional Modifier EP · Child screening program Typical Low $4.57 Median $4.57 Typical High $4.57 | Professional | EP · Child screening program | $4.57 | $4.57 | $4.57 |
Where Georgia sits
The same service costs 2.7 times more in North Dakota than in New Mexico. 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.
Georgia· 44th of 51
$4.37
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.