How much rates vary
Facilitymedian $79 · 10th to 90th $56 to $110Professionalmedian $83 · 10th to 90th $60 to $138
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 $53.70 Median $72.44 Typical High $104.71 | Facility | None | $53.70 | $72.44 | $104.71 |
Aetna Setting Professional Modifier None Typical Low $53.70 Median $72.44 Typical High $100.00 | Professional | None | $53.70 | $72.44 | $100.00 |
Ambetter Setting Professional Modifier None Typical Low $87.10 Median $123.03 Typical High $154.88 | Professional | None | $87.10 | $123.03 | $154.88 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $89.13 Median $112.20 Typical High $165.96 | Professional | 25 · Same-day visit | $89.13 | $112.20 | $165.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $61.66 Median $79.43 Typical High $109.65 | Professional | None | $61.66 | $79.43 | $109.65 |
CareSource Setting Facility Modifier None Typical Low $60.26 Median $77.62 Typical High $107.15 | Facility | None | $60.26 | $77.62 | $107.15 |
CareSource Setting Professional Modifier None Typical Low $102.33 Median $104.71 Typical High $131.83 | Professional | None | $102.33 | $104.71 | $131.83 |
Cigna Setting Facility Modifier None Typical Low $85.11 Median $125.89 Typical High $125.89 | Facility | None | $85.11 | $125.89 | $125.89 |
Cigna Setting Professional Modifier None Typical Low $74.13 Median $100.00 Typical High $562.34 | Professional | None | $74.13 | $100.00 | $562.34 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $79.43 | Professional | None | $33.11 | $33.11 | $79.43 |
United Setting Professional Modifier None Typical Low $64.57 Median $87.10 Typical High $114.82 | Professional | None | $64.57 | $87.10 | $114.82 |
12 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 Facility Modifier 52 · Reduced service Typical Low $35.48 Median $42.66 Typical High $47.86 | Facility | 52 · Reduced service | $35.48 | $42.66 | $47.86 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $10.72 Median $12.88 Typical High $14.45 | Facility | 55 · Aftercare only | $10.72 | $12.88 | $14.45 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $7.08 Median $8.71 Typical High $9.55 | Facility | 56 · Pre-op care only | $7.08 | $8.71 | $9.55 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $31.62 Median $39.81 Typical High $47.86 | Professional | 52 · Reduced service | $31.62 | $39.81 | $47.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.55 Median $12.02 Typical High $14.45 | Professional | 55 · Aftercare only | $9.55 | $12.02 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.46 Median $7.94 Typical High $9.55 | Professional | 56 · Pre-op care only | $6.46 | $7.94 | $9.55 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | 24 · Unrelated visit after surgery | $74.13 | $74.13 | $74.13 |
Ambetter Setting Professional Modifier AF · Specialist physician Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | AF · Specialist physician | $109.65 | $109.65 | $109.65 |
Ambetter Setting Professional Modifier CG · Policy criteria applied Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | CG · Policy criteria applied | $112.20 | $112.20 | $112.20 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $74.13 Median $87.10 Typical High $87.10 | Professional | FS · Shared visit | $74.13 | $87.10 | $87.10 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $87.10 Median $87.10 Typical High $138.04 | Professional | GC · Resident with teaching physician | $87.10 | $87.10 | $138.04 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | Q6 · Substitute physician, paid per time | $109.65 | $109.65 | $109.65 |
Where Kentucky sits
The same service costs 2.3 times more in Alaska than in Alabama. 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.
Kentucky· 47th of 51
$83.18
AK $170AL $74.13
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.