How much rates vary
Facilitymedian $98 · 10th to 90th $54 to $263Professionalmedian $91 · 10th to 90th $65 to $132
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 $61.66 Median $97.72 Typical High $190.55 | Facility | None | $61.66 | $97.72 | $190.55 |
Aetna Setting Professional Modifier None Typical Low $57.54 Median $97.72 Typical High $128.82 | Professional | None | $57.54 | $97.72 | $128.82 |
Ambetter Setting Professional Modifier None Typical Low $72.44 Median $112.20 Typical High $138.04 | Professional | None | $72.44 | $112.20 | $138.04 |
Anthem BCBS Setting Facility Modifier None Typical Low $354.81 Median $489.78 Typical High $549.54 | Facility | None | $354.81 | $489.78 | $549.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $81.28 Median $97.72 Typical High $141.25 | Professional | None | $81.28 | $97.72 | $141.25 |
CDPHP Setting Professional Modifier None Typical Low $117.49 Median $117.49 Typical High $158.49 | Professional | None | $117.49 | $117.49 | $158.49 |
Cigna Setting Facility Modifier None Typical Low $125.89 Median $151.36 Typical High $263.03 | Facility | None | $125.89 | $151.36 | $263.03 |
Cigna Setting Professional Modifier None Typical Low $85.11 Median $93.33 Typical High $186.21 | Professional | None | $85.11 | $93.33 | $186.21 |
Emblem Health Setting Facility Modifier None Typical Low $0.10 Median $54.95 Typical High $186.21 | Facility | None | $0.10 | $54.95 | $186.21 |
Emblem Health Setting Professional Modifier None Typical Low $30.90 Median $77.62 Typical High $81.28 | Professional | None | $30.90 | $77.62 | $81.28 |
Excellus BCBS Setting Facility Modifier None Typical Low $36.31 Median $40.74 Typical High $61.66 | Facility | None | $36.31 | $40.74 | $61.66 |
Excellus BCBS Setting Professional Modifier None Typical Low $74.13 Median $95.50 Typical High $131.83 | Professional | None | $74.13 | $95.50 | $131.83 |
Fidelis Setting Professional Modifier None Typical Low $134.90 Median $134.90 Typical High $141.25 | Professional | None | $134.90 | $134.90 | $141.25 |
Highmark BCBS Setting Facility Modifier None Typical Low $218.78 Median $263.03 Typical High $416.87 | Facility | None | $218.78 | $263.03 | $416.87 |
Highmark BCBS Setting Professional Modifier None Typical Low $117.49 Median $147.91 Typical High $229.09 | Professional | None | $117.49 | $147.91 | $229.09 |
MVP Health Care Setting Facility Modifier None Typical Low $72.44 Median $72.44 Typical High $239.88 | Facility | None | $72.44 | $72.44 | $239.88 |
MVP Health Care Setting Professional Modifier None Typical Low $64.57 Median $64.57 Typical High $151.36 | Professional | None | $64.57 | $64.57 | $151.36 |
Optum Setting Professional Modifier None Typical Low $95.50 Median $123.03 Typical High $123.03 | Professional | None | $95.50 | $123.03 | $123.03 |
United Setting Professional Modifier None Typical Low $52.48 Median $81.28 Typical High $131.83 | Professional | None | $52.48 | $81.28 | $131.83 |
Univera Setting Facility Modifier None Typical Low $38.02 Median $70.79 Typical High $263.03 | Facility | None | $38.02 | $70.79 | $263.03 |
Univera Setting Professional Modifier None Typical Low $74.13 Median $95.50 Typical High $123.03 | Professional | None | $74.13 | $95.50 | $123.03 |
8 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 $28.84 Median $40.74 Typical High $41.69 | Professional | 52 · Reduced service | $28.84 | $40.74 | $41.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $12.02 Typical High $12.30 | Professional | 55 · Aftercare only | $8.51 | $12.02 | $12.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $8.13 Typical High $8.32 | Professional | 56 · Pre-op care only | $5.75 | $8.13 | $8.32 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $97.72 Median $117.49 Typical High $141.25 | Professional | 25 · Same-day visit | $97.72 | $117.49 | $141.25 |
Emblem Health Setting Professional Modifier GQ · Store-and-forward telehealth Typical Low $75.86 Median $79.43 Typical High $79.43 | Professional | GQ · Store-and-forward telehealth | $75.86 | $79.43 | $79.43 |
Emblem Health Setting Professional Modifier HG · Opioid treatment program Typical Low $54.95 Median $54.95 Typical High $54.95 | Professional | HG · Opioid treatment program | $54.95 | $54.95 | $54.95 |
Fidelis Setting Professional Modifier 25 · Same-day visit Typical Low $100.00 Median $144.54 Typical High $162.18 | Professional | 25 · Same-day visit | $100.00 | $144.54 | $162.18 |
Highmark BCBS Setting Professional Modifier 25 · Same-day visit Typical Low $104.71 Median $138.04 Typical High $208.93 | Professional | 25 · Same-day visit | $104.71 | $138.04 | $208.93 |
Where New York 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.
New York· 39th of 51
$91.20
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.