How much rates vary
Facilitymedian $148 · 10th to 90th $95 to $380Professionalmedian $148 · 10th to 90th $102 to $263
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 $97.72 Median $138.04 Typical High $257.04 | Facility | None | $97.72 | $138.04 | $257.04 |
Aetna Setting Professional Modifier None Typical Low $97.72 Median $134.90 Typical High $199.53 | Professional | None | $97.72 | $134.90 | $199.53 |
AllWays Health Partners Setting Facility Modifier None Typical Low $120.23 Median $131.83 Typical High $389.05 | Facility | None | $120.23 | $131.83 | $389.05 |
AllWays Health Partners Setting Professional Modifier None Typical Low $141.25 Median $295.12 Typical High $1,047.13 | Professional | None | $141.25 | $295.12 | $1,047.13 |
Ambetter Setting Professional Modifier None Typical Low $107.15 Median $165.96 Typical High $223.87 | Professional | None | $107.15 | $165.96 | $223.87 |
AmeriHealth Setting Facility Modifier None Typical Low $138.04 Median $870.96 Typical High $2,951.21 | Facility | None | $138.04 | $870.96 | $2,951.21 |
AmeriHealth Setting Professional Modifier None Typical Low $134.90 Median $169.82 Typical High $275.42 | Professional | None | $134.90 | $169.82 | $275.42 |
Anthem BCBS Setting Facility Modifier None Typical Low $134.90 Median $173.78 Typical High $741.31 | Facility | None | $134.90 | $173.78 | $741.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $109.65 Median $141.25 Typical High $223.87 | Professional | None | $109.65 | $141.25 | $223.87 |
Asuris Northwest Health Setting Facility Modifier None Typical Low $87.10 Median $87.10 Typical High $234.42 | Facility | None | $87.10 | $87.10 | $234.42 |
Asuris Northwest Health Setting Professional Modifier None Typical Low $181.97 Median $223.87 Typical High $1,047.13 | Professional | None | $181.97 | $223.87 | $1,047.13 |
Aultcare Setting Professional Modifier None Typical Low $131.83 Median $169.82 Typical High $234.42 | Professional | None | $131.83 | $169.82 | $234.42 |
AvMed Setting Facility Modifier None Typical Low $120.23 Median $147.91 Typical High $194.98 | Facility | None | $120.23 | $147.91 | $194.98 |
AvMed Setting Professional Modifier None Typical Low $117.49 Median $144.54 Typical High $186.21 | Professional | None | $117.49 | $144.54 | $186.21 |
BCBS Alabama Setting Professional Modifier None Typical Low $87.10 Median $204.17 Typical High $316.23 | Professional | None | $87.10 | $204.17 | $316.23 |
BCBS Arizona Setting Professional Modifier None Typical Low $97.72 Median $123.03 Typical High $151.36 | Professional | None | $97.72 | $123.03 | $151.36 |
BCBS Arkansas Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $177.83 | Facility | None | $125.89 | $125.89 | $177.83 |
BCBS Arkansas Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $204.17 | Professional | None | $165.96 | $165.96 | $204.17 |
BCBS Idaho Setting Facility Modifier None Typical Low $15.14 Median $295.12 Typical High $331.13 | Facility | None | $15.14 | $295.12 | $331.13 |
BCBS Idaho Setting Professional Modifier None Typical Low $194.98 Median $251.19 Typical High $346.74 | Professional | None | $194.98 | $251.19 | $346.74 |
BCBS Illinois Setting Facility Modifier None Typical Low $128.82 Median $426.58 Typical High $1,862.09 | Facility | None | $128.82 | $426.58 | $1,862.09 |
BCBS Illinois Setting Professional Modifier None Typical Low $128.82 Median $151.36 Typical High $194.98 | Professional | None | $128.82 | $151.36 | $194.98 |
BCBS Kansas Setting Facility Modifier None Typical Low $95.50 Median $100.00 Typical High $100.00 | Facility | None | $95.50 | $100.00 | $100.00 |
BCBS Kansas Setting Professional Modifier None Typical Low $144.54 Median $169.82 Typical High $213.80 | Professional | None | $144.54 | $169.82 | $213.80 |
BCBS Kansas City Setting Professional Modifier None Typical Low $117.49 Median $169.82 Typical High $204.17 | Professional | None | $117.49 | $169.82 | $204.17 |
BCBS Louisiana Setting Facility Modifier None Typical Low $38.02 Median $79.43 Typical High $346.74 | Facility | None | $38.02 | $79.43 | $346.74 |
BCBS Louisiana Setting Professional Modifier None Typical Low $128.82 Median $151.36 Typical High $162.18 | Professional | None | $128.82 | $151.36 | $162.18 |
BCBS Massachusetts Setting Facility Modifier None Typical Low $128.82 Median $302.00 Typical High $407.38 | Facility | None | $128.82 | $302.00 | $407.38 |
BCBS Massachusetts Setting Professional Modifier None Typical Low $128.82 Median $204.17 Typical High $346.74 | Professional | None | $128.82 | $204.17 | $346.74 |
BCBS Michigan Setting Facility Modifier None Typical Low $117.49 Median $194.98 Typical High $389.05 | Facility | None | $117.49 | $194.98 | $389.05 |
BCBS Michigan Setting Professional Modifier None Typical Low $144.54 Median $165.96 Typical High $208.93 | Professional | None | $144.54 | $165.96 | $208.93 |
BCBS Minnesota Setting Facility Modifier None Typical Low $234.42 Median $489.78 Typical High $1,380.38 | Facility | None | $234.42 | $489.78 | $1,380.38 |
BCBS Minnesota Setting Professional Modifier None Typical Low $162.18 Median $263.03 Typical High $416.87 | Professional | None | $162.18 | $263.03 | $416.87 |
BCBS Mississippi Setting Facility Modifier None Typical Low $91.20 Median $91.20 Typical High $128.82 | Facility | None | $91.20 | $91.20 | $128.82 |
BCBS Mississippi Setting Professional Modifier None Typical Low $151.36 Median $169.82 Typical High $169.82 | Professional | None | $151.36 | $169.82 | $169.82 |
BCBS Montana Setting Professional Modifier None Typical Low $208.93 Median $223.87 Typical High $263.03 | Professional | None | $208.93 | $223.87 | $263.03 |
BCBS Nebraska Setting Facility Modifier None Typical Low $147.91 Median $154.88 Typical High $158.49 | Facility | None | $147.91 | $154.88 | $158.49 |
BCBS Nebraska Setting Professional Modifier None Typical Low $109.65 Median $186.21 Typical High $251.19 | Professional | None | $109.65 | $186.21 | $251.19 |
BCBS New Mexico Setting Professional Modifier None Typical Low $87.10 Median $147.91 Typical High $162.18 | Professional | None | $87.10 | $147.91 | $162.18 |
BCBS North Carolina Setting Professional Modifier None Typical Low $169.82 Median $251.19 Typical High $354.81 | Professional | None | $169.82 | $251.19 | $354.81 |
BCBS North Dakota Setting Facility Modifier None Typical Low $316.23 Median $363.08 Typical High $416.87 | Facility | None | $316.23 | $363.08 | $416.87 |
BCBS Oklahoma Setting Professional Modifier None Typical Low $131.83 Median $158.49 Typical High $218.78 | Professional | None | $131.83 | $158.49 | $218.78 |
BCBS Rhode Island Setting Facility Modifier None Typical Low $154.88 Median $281.84 Typical High $436.52 | Facility | None | $154.88 | $281.84 | $436.52 |
BCBS Rhode Island Setting Professional Modifier None Typical Low $131.83 Median $173.78 Typical High $223.87 | Professional | None | $131.83 | $173.78 | $223.87 |
BCBS South Carolina Setting Facility Modifier None Typical Low $141.25 Median $190.55 Typical High $602.56 | Facility | None | $141.25 | $190.55 | $602.56 |
BCBS South Carolina Setting Professional Modifier None Typical Low $93.33 Median $114.82 Typical High $158.49 | Professional | None | $93.33 | $114.82 | $158.49 |
BCBS Tennessee Setting Professional Modifier None Typical Low $120.23 Median $151.36 Typical High $229.09 | Professional | None | $120.23 | $151.36 | $229.09 |
BCBS Texas Setting Facility Modifier None Typical Low $141.25 Median $354.81 Typical High $691.83 | Facility | None | $141.25 | $354.81 | $691.83 |
BCBS Texas Setting Professional Modifier None Typical Low $109.65 Median $138.04 Typical High $204.17 | Professional | None | $109.65 | $138.04 | $204.17 |
BCBS Vermont Setting Facility Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Facility | None | $204.17 | $204.17 | $204.17 |
BCBS Vermont Setting Professional Modifier None Typical Low $194.98 Median $245.47 Typical High $245.47 | Professional | None | $194.98 | $245.47 | $245.47 |
BCBS Wyoming Setting Professional Modifier None Typical Low $194.98 Median $239.88 Typical High $302.00 | Professional | None | $194.98 | $239.88 | $302.00 |
Baylor Scott & White Setting Professional Modifier None Typical Low $120.23 Median $177.83 Typical High $223.87 | Professional | None | $120.23 | $177.83 | $223.87 |
Blue Shield Setting Facility Modifier None Typical Low $64.57 Median $83.18 Typical High $89.13 | Facility | None | $64.57 | $83.18 | $89.13 |
Blue Shield Setting Professional Modifier None Typical Low $114.82 Median $162.18 Typical High $190.55 | Professional | None | $114.82 | $162.18 | $190.55 |
CDPHP Setting Professional Modifier None Typical Low $190.55 Median $190.55 Typical High $234.42 | Professional | None | $190.55 | $190.55 | $234.42 |
Capital Blue Cross Setting Facility Modifier None Typical Low $4,265.80 Median $5,011.87 Typical High $79,432.82 | Facility | None | $4,265.80 | $5,011.87 | $79,432.82 |
Capital Blue Cross Setting Professional Modifier None Typical Low $234.42 Median $295.12 Typical High $323.59 | Professional | None | $234.42 | $295.12 | $323.59 |
CareFirst Setting Professional Modifier None Typical Low $114.82 Median $120.23 Typical High $154.88 | Professional | None | $114.82 | $120.23 | $154.88 |
CareSource Setting Facility Modifier None Typical Low $104.71 Median $128.82 Typical High $173.78 | Facility | None | $104.71 | $128.82 | $173.78 |
CareSource Setting Professional Modifier None Typical Low $154.88 Median $165.96 Typical High $218.78 | Professional | None | $154.88 | $165.96 | $218.78 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $117.49 Median $144.54 Typical High $239.88 | Professional | None | $117.49 | $144.54 | $239.88 |
Christus Setting Facility Modifier None Typical Low $134.90 Median $134.90 Typical High $134.90 | Facility | None | $134.90 | $134.90 | $134.90 |
Cigna Setting Facility Modifier None Typical Low $109.65 Median $151.36 Typical High $251.19 | Facility | None | $109.65 | $151.36 | $251.19 |
Cigna Setting Professional Modifier None Typical Low $107.15 Median $147.91 Typical High $257.04 | Professional | None | $107.15 | $147.91 | $257.04 |
Community Health Options Setting Professional Modifier None Typical Low $194.98 Median $251.19 Typical High $338.84 | Professional | None | $194.98 | $251.19 | $338.84 |
ConnectiCare Setting Professional Modifier None Typical Low $81.28 Median $190.55 Typical High $346.74 | Professional | None | $81.28 | $190.55 | $346.74 |
Contra Costa Health Setting Professional Modifier None Typical Low $69.18 Median $141.25 Typical High $234.42 | Professional | None | $69.18 | $141.25 | $234.42 |
DeanCare Setting Facility Modifier None Typical Low $117.49 Median $154.88 Typical High $316.23 | Facility | None | $117.49 | $154.88 | $316.23 |
DeanCare Setting Professional Modifier None Typical Low $199.53 Median $275.42 Typical High $346.74 | Professional | None | $199.53 | $275.42 | $346.74 |
Denver HMP Setting Facility Modifier None Typical Low $128.82 Median $173.78 Typical High $239.88 | Facility | None | $128.82 | $173.78 | $239.88 |
Denver HMP Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | None | $204.17 | $204.17 | $204.17 |
Emblem Health Setting Facility Modifier None Typical Low $0.10 Median $56.23 Typical High $302.00 | Facility | None | $0.10 | $56.23 | $302.00 |
Emblem Health Setting Professional Modifier None Typical Low $30.90 Median $81.28 Typical High $93.33 | Professional | None | $30.90 | $81.28 | $93.33 |
Excellus BCBS Setting Facility Modifier None Typical Low $36.31 Median $45.71 Typical High $67.61 | Facility | None | $36.31 | $45.71 | $67.61 |
Excellus BCBS Setting Professional Modifier None Typical Low $109.65 Median $144.54 Typical High $186.21 | Professional | None | $109.65 | $144.54 | $186.21 |
Fallon Health Setting Facility Modifier None Typical Low $70.79 Median $109.65 Typical High $190.55 | Facility | None | $70.79 | $109.65 | $190.55 |
Fallon Health Setting Professional Modifier None Typical Low $117.49 Median $181.97 Typical High $302.00 | Professional | None | $117.49 | $181.97 | $302.00 |
Fidelis Setting Professional Modifier None Typical Low $173.78 Median $213.80 Typical High $213.80 | Professional | None | $173.78 | $213.80 | $213.80 |
Florida Blue Setting Facility Modifier None Typical Low $30.90 Median $30.90 Typical High $275.42 | Facility | None | $30.90 | $30.90 | $275.42 |
Florida Blue Setting Professional Modifier None Typical Low $75.86 Median $138.04 Typical High $190.55 | Professional | None | $75.86 | $138.04 | $190.55 |
Geisinger Setting Facility Modifier None Typical Low $134.90 Median $134.90 Typical High $158.49 | Facility | None | $134.90 | $134.90 | $158.49 |
Geisinger Setting Professional Modifier None Typical Low $134.90 Median $181.97 Typical High $309.03 | Professional | None | $134.90 | $181.97 | $309.03 |
HMSA Setting Professional Modifier None Typical Low $25.12 Median $30.20 Typical High $44.67 | Professional | None | $25.12 | $30.20 | $44.67 |
Hally Health Setting Professional Modifier None Typical Low $131.83 Median $194.98 Typical High $354.81 | Professional | None | $131.83 | $194.98 | $354.81 |
Hally Health Setting Facility Modifier None Typical Low $100.00 Median $100.00 Typical High $100.00 | Facility | None | $100.00 | $100.00 | $100.00 |
Hally Health Setting Professional Modifier None Typical Low $158.49 Median $190.55 Typical High $223.87 | Professional | None | $158.49 | $190.55 | $223.87 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $141.25 Median $239.88 Typical High $467.74 | Professional | None | $141.25 | $239.88 | $467.74 |
Health Alliance Plan Setting Facility Modifier None Typical Low $63.10 Median $134.90 Typical High $190.55 | Facility | None | $63.10 | $134.90 | $190.55 |
Health Alliance Plan Setting Professional Modifier None Typical Low $104.71 Median $144.54 Typical High $223.87 | Professional | None | $104.71 | $144.54 | $223.87 |
Health New England Setting Facility Modifier None Typical Low $173.78 Median $199.53 Typical High $501.19 | Facility | None | $173.78 | $199.53 | $501.19 |
Health New England Setting Professional Modifier None Typical Low $190.55 Median $275.42 Typical High $1,000.00 | Professional | None | $190.55 | $275.42 | $1,000.00 |
Health Partners Setting Facility Modifier None Typical Low $346.74 Median $549.54 Typical High $1,318.26 | Facility | None | $346.74 | $549.54 | $1,318.26 |
Health Partners Setting Professional Modifier None Typical Low $218.78 Median $302.00 Typical High $489.78 | Professional | None | $218.78 | $302.00 | $489.78 |
Health Smart Setting Facility Modifier None Typical Low $169.82 Median $169.82 Typical High $186.21 | Facility | None | $169.82 | $169.82 | $186.21 |
Health Smart Setting Professional Modifier None Typical Low $154.88 Median $194.98 Typical High $275.42 | Professional | None | $154.88 | $194.98 | $275.42 |
HealthNet Setting Professional Modifier None Typical Low $194.98 Median $275.42 Typical High $467.74 | Professional | None | $194.98 | $275.42 | $467.74 |
Highmark BCBS Setting Facility Modifier None Typical Low $75.86 Median $275.42 Typical High $446.68 | Facility | None | $75.86 | $275.42 | $446.68 |
Highmark BCBS Setting Professional Modifier None Typical Low $144.54 Median $194.98 Typical High $302.00 | Professional | None | $144.54 | $194.98 | $302.00 |
Hometown Health Setting Professional Modifier None Typical Low $102.33 Median $144.54 Typical High $208.93 | Professional | None | $102.33 | $144.54 | $208.93 |
Hometown Health Setting Professional Modifier None Typical Low $1.00 Median $128.82 Typical High $263.03 | Professional | None | $1.00 | $128.82 | $263.03 |
Horizon BCBS Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $245.47 | Professional | None | $165.96 | $165.96 | $245.47 |
Independence Blue Cross Setting Facility Modifier None Typical Low $177.83 Median $177.83 Typical High $2,570.40 | Facility | None | $177.83 | $177.83 | $2,570.40 |
Independence Blue Cross Setting Professional Modifier None Typical Low $141.25 Median $158.49 Typical High $190.55 | Professional | None | $141.25 | $158.49 | $190.55 |
Kaiser Permanente Setting Professional Modifier None Typical Low $120.23 Median $186.21 Typical High $288.40 | Professional | None | $120.23 | $186.21 | $288.40 |
Kaiser Permanente Setting Professional Modifier None Typical Low $107.15 Median $169.82 Typical High $323.59 | Professional | None | $107.15 | $169.82 | $323.59 |
Lucent Health Setting Professional Modifier None Typical Low $194.98 Median $1,047.13 Typical High $1,047.13 | Professional | None | $194.98 | $1,047.13 | $1,047.13 |
MVP Health Care Setting Facility Modifier None Typical Low $123.03 Median $123.03 Typical High $239.88 | Facility | None | $123.03 | $123.03 | $239.88 |
MVP Health Care Setting Professional Modifier None Typical Low $100.00 Median $100.00 Typical High $234.42 | Professional | None | $100.00 | $100.00 | $234.42 |
Martin's Point Setting Facility Modifier None Typical Low $107.15 Median $138.04 Typical High $251.19 | Facility | None | $107.15 | $138.04 | $251.19 |
Martin's Point Setting Professional Modifier None Typical Low $104.71 Median $138.04 Typical High $181.97 | Professional | None | $104.71 | $138.04 | $181.97 |
Mass General Brigham Setting Facility Modifier None Typical Low $120.23 Median $131.83 Typical High $389.05 | Facility | None | $120.23 | $131.83 | $389.05 |
Mass General Brigham Setting Professional Modifier None Typical Low $141.25 Median $295.12 Typical High $1,047.13 | Professional | None | $141.25 | $295.12 | $1,047.13 |
Medcost Setting Professional Modifier None Typical Low $131.83 Median $177.83 Typical High $204.17 | Professional | None | $131.83 | $177.83 | $204.17 |
Medcost Setting Facility Modifier None Typical Low $123.03 Median $162.18 Typical High $204.17 | Facility | None | $123.03 | $162.18 | $204.17 |
Medcost Setting Professional Modifier None Typical Low $50.12 Median $158.49 Typical High $199.53 | Professional | None | $50.12 | $158.49 | $199.53 |
Medica Setting Facility Modifier None Typical Low $117.49 Median $199.53 Typical High $457.09 | Facility | None | $117.49 | $199.53 | $457.09 |
Medica Setting Professional Modifier None Typical Low $147.91 Median $831.76 Typical High $1,047.13 | Professional | None | $147.91 | $831.76 | $1,047.13 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $89.13 Median $128.82 Typical High $181.97 | Facility | None | $89.13 | $128.82 | $181.97 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $120.23 Median $204.17 Typical High $309.03 | Professional | None | $120.23 | $204.17 | $309.03 |
Midlands Setting Professional Modifier None Typical Low $213.80 Median $269.15 Typical High $354.81 | Professional | None | $213.80 | $269.15 | $354.81 |
Midlands Setting Professional Modifier None Typical Low $229.09 Median $316.23 Typical High $446.68 | Professional | None | $229.09 | $316.23 | $446.68 |
Moda Health Setting Facility Modifier None Typical Low $112.20 Median $181.97 Typical High $457.09 | Facility | None | $112.20 | $181.97 | $457.09 |
Moda Health Setting Professional Modifier None Typical Low $109.65 Median $151.36 Typical High $257.04 | Professional | None | $109.65 | $151.36 | $257.04 |
Molina Setting Professional Modifier None Typical Low $26.30 Median $147.91 Typical High $234.42 | Professional | None | $26.30 | $147.91 | $234.42 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $190.55 Median $229.09 Typical High $316.23 | Facility | None | $190.55 | $229.09 | $316.23 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $199.53 Median $251.19 Typical High $316.23 | Professional | None | $199.53 | $251.19 | $316.23 |
Network Health Setting Facility Modifier None Typical Low $199.53 Median $199.53 Typical High $257.04 | Facility | None | $199.53 | $199.53 | $257.04 |
Network Health Setting Professional Modifier None Typical Low $123.03 Median $234.42 Typical High $338.84 | Professional | None | $123.03 | $234.42 | $338.84 |
Optum Setting Professional Modifier None Typical Low $151.36 Median $173.78 Typical High $194.98 | Professional | None | $151.36 | $173.78 | $194.98 |
Oscar Health Setting Professional Modifier None Typical Low $128.82 Median $218.78 Typical High $380.19 | Professional | None | $128.82 | $218.78 | $380.19 |
Pacific Source Setting Facility Modifier None Typical Low $177.83 Median $309.03 Typical High $331.13 | Facility | None | $177.83 | $309.03 | $331.13 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $251.19 Median $416.87 Typical High $2,089.30 | Facility | None | $251.19 | $416.87 | $2,089.30 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $112.20 Median $158.49 Typical High $234.42 | Professional | None | $112.20 | $158.49 | $234.42 |
Premera BCBS Setting Facility Modifier None Typical Low $218.78 Median $223.87 Typical High $223.87 | Facility | None | $218.78 | $223.87 | $223.87 |
Premera BCBS Setting Professional Modifier None Typical Low $173.78 Median $218.78 Typical High $323.59 | Professional | None | $173.78 | $218.78 | $323.59 |
Prevea360 Setting Facility Modifier None Typical Low $117.49 Median $154.88 Typical High $316.23 | Facility | None | $117.49 | $154.88 | $316.23 |
Priority Health Setting Facility Modifier None Typical Low $151.36 Median $151.36 Typical High $151.36 | Facility | None | $151.36 | $151.36 | $151.36 |
Priority Health Setting Professional Modifier None Typical Low $125.89 Median $151.36 Typical High $181.97 | Professional | None | $125.89 | $151.36 | $181.97 |
Providence Setting Facility Modifier None Typical Low $120.23 Median $162.18 Typical High $257.04 | Facility | None | $120.23 | $162.18 | $257.04 |
Providence Setting Professional Modifier None Typical Low $114.82 Median $151.36 Typical High $257.04 | Professional | None | $114.82 | $151.36 | $257.04 |
Qualchoice Setting Professional Modifier None Typical Low $91.20 Median $173.78 Typical High $218.78 | Professional | None | $91.20 | $173.78 | $218.78 |
Quartz Setting Professional Modifier None Typical Low $147.91 Median $275.42 Typical High $407.38 | Professional | None | $147.91 | $275.42 | $407.38 |
Quartz Setting Professional Modifier None Typical Low $131.83 Median $158.49 Typical High $223.87 | Professional | None | $131.83 | $158.49 | $223.87 |
Regence BlueShield Setting Facility Modifier None Typical Low $295.12 Median $295.12 Typical High $371.54 | Facility | None | $295.12 | $295.12 | $371.54 |
Regence BlueShield Setting Professional Modifier None Typical Low $154.88 Median $218.78 Typical High $295.12 | Professional | None | $154.88 | $218.78 | $295.12 |
Sanford Health Plan Setting Professional Modifier None Typical Low $147.91 Median $204.17 Typical High $309.03 | Professional | None | $147.91 | $204.17 | $309.03 |
Security Health Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $194.98 | Professional | None | $158.49 | $158.49 | $194.98 |
Security Health Setting Professional Modifier None Typical Low $173.78 Median $239.88 Typical High $371.54 | Professional | None | $173.78 | $239.88 | $371.54 |
Select Health Setting Facility Modifier None Typical Low $165.96 Median $181.97 Typical High $380.19 | Facility | None | $165.96 | $181.97 | $380.19 |
Select Health Setting Professional Modifier None Typical Low $104.71 Median $158.49 Typical High $467.74 | Professional | None | $104.71 | $158.49 | $467.74 |
Sentara Setting Facility Modifier None Typical Low $104.71 Median $154.88 Typical High $758.58 | Facility | None | $104.71 | $154.88 | $758.58 |
Sentara Setting Professional Modifier None Typical Low $144.54 Median $173.78 Typical High $229.09 | Professional | None | $144.54 | $173.78 | $229.09 |
SummaCare Setting Professional Modifier None Typical Low $120.23 Median $138.04 Typical High $223.87 | Professional | None | $120.23 | $138.04 | $223.87 |
Sutter Health Plus Setting Professional Modifier None Typical Low $75.86 Median $331.13 Typical High $426.58 | Professional | None | $75.86 | $331.13 | $426.58 |
The Alliance Setting Professional Modifier None Typical Low $165.96 Median $263.03 Typical High $398.11 | Professional | None | $165.96 | $263.03 | $398.11 |
Tufts Setting Facility Modifier None Typical Low $37.15 Median $102.33 Typical High $489.78 | Facility | None | $37.15 | $102.33 | $489.78 |
Tufts Setting Professional Modifier None Typical Low $102.33 Median $162.18 Typical High $316.23 | Professional | None | $102.33 | $162.18 | $316.23 |
U of Utah Health Plan Setting Professional Modifier None Typical Low $131.83 Median $208.93 Typical High $416.87 | Professional | None | $131.83 | $208.93 | $416.87 |
UPMC Health Plan Setting Facility Modifier None Typical Low $128.82 Median $162.18 Typical High $371.54 | Facility | None | $128.82 | $162.18 | $371.54 |
UPMC Health Plan Setting Professional Modifier None Typical Low $128.82 Median $138.04 Typical High $162.18 | Professional | None | $128.82 | $138.04 | $162.18 |
United Setting Facility Modifier None Typical Low $69.18 Median $69.18 Typical High $131.83 | Facility | None | $69.18 | $69.18 | $131.83 |
United Setting Professional Modifier None Typical Low $100.00 Median $141.25 Typical High $234.42 | Professional | None | $100.00 | $141.25 | $234.42 |
Univera Setting Facility Modifier None Typical Low $45.71 Median $114.82 Typical High $389.05 | Facility | None | $45.71 | $114.82 | $389.05 |
Univera Setting Professional Modifier None Typical Low $109.65 Median $144.54 Typical High $186.21 | Professional | None | $109.65 | $144.54 | $186.21 |
University Health Alliance Setting Professional Modifier None Typical Low $151.36 Median $223.87 Typical High $223.87 | Professional | None | $151.36 | $223.87 | $223.87 |
Well Sense Setting Facility Modifier None Typical Low $109.65 Median $158.49 Typical High $251.19 | Facility | None | $109.65 | $158.49 | $251.19 |
Well Sense Setting Professional Modifier None Typical Low $87.10 Median $87.10 Typical High $104.71 | Professional | None | $87.10 | $87.10 | $104.71 |
Wellmark Setting Professional Modifier None Typical Low $158.49 Median $177.83 Typical High $245.47 | Professional | None | $158.49 | $177.83 | $245.47 |
Wellpoint Setting Professional Modifier None Typical Low $91.20 Median $173.78 Typical High $177.83 | Professional | None | $91.20 | $173.78 | $177.83 |
146 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 $52.48 Median $66.07 Typical High $81.28 | Facility | 52 · Reduced service | $52.48 | $66.07 | $81.28 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $15.85 Median $19.50 Typical High $24.55 | Facility | 55 · Aftercare only | $15.85 | $19.50 | $24.55 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $10.47 Median $13.18 Typical High $16.22 | Facility | 56 · Pre-op care only | $10.47 | $13.18 | $16.22 |
Aetna Setting Facility Modifier AF · Specialist physician Typical Low $107.15 Median $165.96 Typical High $190.55 | Facility | AF · Specialist physician | $107.15 | $165.96 | $190.55 |
Aetna Setting Facility Modifier HO · Master's level Typical Low $81.28 Median $123.03 Typical High $144.54 | Facility | HO · Master's level | $81.28 | $123.03 | $144.54 |
Aetna Setting Facility Modifier TD · Registered nurse Typical Low $93.33 Median $141.25 Typical High $162.18 | Facility | TD · Registered nurse | $93.33 | $141.25 | $162.18 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $51.29 Median $64.57 Typical High $83.18 | Professional | 52 · Reduced service | $51.29 | $64.57 | $83.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $19.05 Typical High $24.55 | Professional | 55 · Aftercare only | $15.49 | $19.05 | $24.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $12.88 Typical High $16.60 | Professional | 56 · Pre-op care only | $10.23 | $12.88 | $16.60 |
Aetna Setting Professional Modifier AF · Specialist physician Typical Low $109.65 Median $144.54 Typical High $213.80 | Professional | AF · Specialist physician | $109.65 | $144.54 | $213.80 |
Aetna Setting Professional Modifier GQ · Store-and-forward telehealth Typical Low $263.03 Median $331.13 Typical High $331.13 | Professional | GQ · Store-and-forward telehealth | $263.03 | $331.13 | $331.13 |
Aetna Setting Professional Modifier HO · Master's level Typical Low $83.18 Median $109.65 Typical High $165.96 | Professional | HO · Master's level | $83.18 | $109.65 | $165.96 |
Aetna Setting Professional Modifier TD · Registered nurse Typical Low $95.50 Median $123.03 Typical High $181.97 | Professional | TD · Registered nurse | $95.50 | $123.03 | $181.97 |
AllWays Health Partners Setting Professional Modifier 25 · Same-day visit Typical Low $70.79 Median $138.04 Typical High $239.88 | Professional | 25 · Same-day visit | $70.79 | $138.04 | $239.88 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $141.25 Median $181.97 Typical High $323.59 | Professional | 24 · Unrelated visit after surgery | $141.25 | $181.97 | $323.59 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $128.82 Median $169.82 Typical High $229.09 | Professional | 25 · Same-day visit | $128.82 | $169.82 | $229.09 |
Ambetter Setting Professional Modifier 32 · Mandated service Typical Low $194.98 Median $194.98 Typical High $194.98 | Professional | 32 · Mandated service | $194.98 | $194.98 | $194.98 |
Ambetter Setting Professional Modifier 33 · Preventive service Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | 33 · Preventive service | $186.21 | $186.21 | $186.21 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $120.23 Median $186.21 Typical High $257.04 | Professional | 57 · Decision for surgery | $120.23 | $186.21 | $257.04 |
Ambetter Setting Professional Modifier 93 · Audio-only telehealth Typical Low $114.82 Median $123.03 Typical High $173.78 | Professional | 93 · Audio-only telehealth | $114.82 | $123.03 | $173.78 |
Ambetter Setting Professional Modifier AF · Specialist physician Typical Low $165.96 Median $165.96 Typical High $165.96 | Professional | AF · Specialist physician | $165.96 | $165.96 | $165.96 |
Ambetter Setting Professional Modifier AI · Physician of record Typical Low $125.89 Median $125.89 Typical High $125.89 | Professional | AI · Physician of record | $125.89 | $125.89 | $125.89 |
Ambetter Setting Professional Modifier AM · Physician, team member Typical Low $173.78 Median $173.78 Typical High $199.53 | Professional | AM · Physician, team member | $173.78 | $173.78 | $199.53 |
Ambetter Setting Professional Modifier AQ · Shortage area physician Typical Low $165.96 Median $165.96 Typical High $208.93 | Professional | AQ · Shortage area physician | $165.96 | $165.96 | $208.93 |
Ambetter Setting Professional Modifier CC · Code corrected Typical Low $169.82 Median $169.82 Typical High $169.82 | Professional | CC · Code corrected | $169.82 | $169.82 | $169.82 |
Ambetter Setting Professional Modifier CG · Policy criteria applied Typical Low $158.49 Median $162.18 Typical High $162.18 | Professional | CG · Policy criteria applied | $158.49 | $162.18 | $162.18 |
Ambetter Setting Professional Modifier FP · Family planning Typical Low $165.96 Median $169.82 Typical High $190.55 | Professional | FP · Family planning | $165.96 | $169.82 | $190.55 |
Ambetter Setting Professional Modifier FQ · Audio-only Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | FQ · Audio-only | $109.65 | $109.65 | $109.65 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $131.83 Median $165.96 Typical High $229.09 | Professional | FS · Shared visit | $131.83 | $165.96 | $229.09 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $117.49 Median $165.96 Typical High $257.04 | Professional | GC · Resident with teaching physician | $117.49 | $165.96 | $257.04 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | GE · Resident, primary care exception | $186.21 | $186.21 | $186.21 |
Ambetter Setting Professional Modifier GF · Non-physician, rural hospital Typical Low $177.83 Median $199.53 Typical High $199.53 | Professional | GF · Non-physician, rural hospital | $177.83 | $199.53 | $199.53 |
Ambetter Setting Professional Modifier GQ · Store-and-forward telehealth Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | GQ · Store-and-forward telehealth | $173.78 | $173.78 | $173.78 |
Ambetter Setting Professional Modifier GY · Excluded by law Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | GY · Excluded by law | $173.78 | $173.78 | $173.78 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $177.83 Median $177.83 Typical High $204.17 | Professional | KX · Policy requirements met | $177.83 | $177.83 | $204.17 |
Ambetter Setting Professional Modifier PD · Before inpatient admission Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | PD · Before inpatient admission | $239.88 | $239.88 | $239.88 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $114.82 Median $173.78 Typical High $186.21 | Professional | Q6 · Substitute physician, paid per time | $114.82 | $173.78 | $186.21 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $109.65 Median $165.96 Typical High $181.97 | Professional | SA · Nurse practitioner | $109.65 | $165.96 | $181.97 |
Ambetter Setting Professional Modifier SC · Medically necessary Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | SC · Medically necessary | $173.78 | $173.78 | $173.78 |
Ambetter Setting Professional Modifier TH · Pregnancy care Typical Low $134.90 Median $181.97 Typical High $204.17 | Professional | TH · Pregnancy care | $134.90 | $181.97 | $204.17 |
Ambetter Setting Professional Modifier TR · School services, out of district Typical Low $165.96 Median $165.96 Typical High $165.96 | Professional | TR · School services, out of district | $165.96 | $165.96 | $165.96 |
Ambetter Setting Professional Modifier U1 · State-defined Typical Low $147.91 Median $147.91 Typical High $147.91 | Professional | U1 · State-defined | $147.91 | $147.91 | $147.91 |
Ambetter Setting Professional Modifier U2 · State-defined Typical Low $165.96 Median $165.96 Typical High $257.04 | Professional | U2 · State-defined | $165.96 | $165.96 | $257.04 |
Ambetter Setting Professional Modifier U6 · State-defined Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | U6 · State-defined | $173.78 | $173.78 | $173.78 |
Ambetter Setting Professional Modifier U7 · State-defined Typical Low $125.89 Median $173.78 Typical High $173.78 | Professional | U7 · State-defined | $125.89 | $173.78 | $173.78 |
Ambetter Setting Professional Modifier UD · State-defined Typical Low $144.54 Median $173.78 Typical High $173.78 | Professional | UD · State-defined | $144.54 | $173.78 | $173.78 |
Anthem BCBS Setting Professional Modifier 25 · Same-day visit Typical Low $125.89 Median $125.89 Typical High $125.89 | Professional | 25 · Same-day visit | $125.89 | $125.89 | $125.89 |
Anthem BCBS Setting Professional Modifier EP · Child screening program Typical Low $109.65 Median $109.65 Typical High $165.96 | Professional | EP · Child screening program | $109.65 | $109.65 | $165.96 |
Anthem BCBS Setting Professional Modifier GQ · Store-and-forward telehealth Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | GQ · Store-and-forward telehealth | $239.88 | $239.88 | $239.88 |
BCBS Alabama Setting Professional Modifier 10 Typical Low $97.72 Median $134.90 Typical High $194.98 | Professional | 10 | $97.72 | $134.90 | $194.98 |
BCBS Idaho Setting Professional Modifier 78 · Unplanned return to OR Typical Low $151.36 Median $165.96 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $151.36 | $165.96 | $251.19 |
BCBS Massachusetts Setting Professional Modifier 52 · Reduced service Typical Low $102.33 Median $151.36 Typical High $229.09 | Professional | 52 · Reduced service | $102.33 | $151.36 | $229.09 |
BCBS Massachusetts Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $69.18 Typical High $134.90 | Professional | 53 · Discontinued | $43.65 | $69.18 | $134.90 |
BCBS Massachusetts Setting Professional Modifier 80 · Assistant surgeon Typical Low $27.54 Median $39.81 Typical High $63.10 | Professional | 80 · Assistant surgeon | $27.54 | $39.81 | $63.10 |
BCBS Massachusetts Setting Professional Modifier AS · PA/NP assist Typical Low $32.36 Median $56.23 Typical High $74.13 | Professional | AS · PA/NP assist | $32.36 | $56.23 | $74.13 |
BCBS Michigan Setting Professional Modifier HO · Master's level Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | HO · Master's level | $177.83 | $177.83 | $177.83 |
BCBS Minnesota Setting Professional Modifier 25 · Same-day visit Typical Low $128.82 Median $208.93 Typical High $338.84 | Professional | 25 · Same-day visit | $128.82 | $208.93 | $338.84 |
BCBS North Dakota Setting Professional Modifier 53 · Discontinued Typical Low $97.72 Median $128.82 Typical High $173.78 | Professional | 53 · Discontinued | $97.72 | $128.82 | $173.78 |
BCBS North Dakota Setting Professional Modifier AF · Specialist physician Typical Low $194.98 Median $257.04 Typical High $346.74 | Professional | AF · Specialist physician | $194.98 | $257.04 | $346.74 |
BCBS South Carolina Setting Professional Modifier 29 Typical Low $93.33 Median $114.82 Typical High $169.82 | Professional | 29 | $93.33 | $114.82 | $169.82 |
BCBS Wyoming Setting Professional Modifier 53 · Discontinued Typical Low $134.90 Median $165.96 Typical High $208.93 | Professional | 53 · Discontinued | $134.90 | $165.96 | $208.93 |
BCBS Wyoming Setting Professional Modifier 55 · Aftercare only Typical Low $38.90 Median $47.86 Typical High $60.26 | Professional | 55 · Aftercare only | $38.90 | $47.86 | $60.26 |
DeanCare Setting Professional Modifier 80 · Assistant surgeon Typical Low $32.36 Median $44.67 Typical High $56.23 | Professional | 80 · Assistant surgeon | $32.36 | $44.67 | $56.23 |
DeanCare Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $32.36 Median $44.67 Typical High $56.23 | Professional | 81 · Minimal assistant surgeon | $32.36 | $44.67 | $56.23 |
DeanCare Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $32.36 Median $44.67 Typical High $56.23 | Professional | 82 · Assistant surgeon, no resident | $32.36 | $44.67 | $56.23 |
DeanCare Setting Professional Modifier AS · PA/NP assist Typical Low $28.18 Median $38.90 Typical High $48.98 | Professional | AS · PA/NP assist | $28.18 | $38.90 | $48.98 |
Emblem Health Setting Professional Modifier GQ · Store-and-forward telehealth Typical Low $112.20 Median $120.23 Typical High $120.23 | Professional | GQ · Store-and-forward telehealth | $112.20 | $120.23 | $120.23 |
Emblem Health Setting Professional Modifier HG · Opioid treatment program Typical Low $104.71 Median $104.71 Typical High $104.71 | Professional | HG · Opioid treatment program | $104.71 | $104.71 | $104.71 |
Fallon Health Setting Facility Modifier SA · Nurse practitioner Typical Low $131.83 Median $169.82 Typical High $234.42 | Facility | SA · Nurse practitioner | $131.83 | $169.82 | $234.42 |
Fallon Health Setting Facility Modifier TD · Registered nurse Typical Low $169.82 Median $169.82 Typical High $181.97 | Facility | TD · Registered nurse | $169.82 | $169.82 | $181.97 |
Fallon Health Setting Facility Modifier U6 · State-defined Typical Low $154.88 Median $199.53 Typical High $269.15 | Facility | U6 · State-defined | $154.88 | $199.53 | $269.15 |
Fallon Health Setting Facility Modifier UG · Afternoon Typical Low $162.18 Median $162.18 Typical High $190.55 | Facility | UG · Afternoon | $162.18 | $162.18 | $190.55 |
Fallon Health Setting Professional Modifier SA · Nurse practitioner Typical Low $169.82 Median $169.82 Typical High $181.97 | Professional | SA · Nurse practitioner | $169.82 | $169.82 | $181.97 |
Fallon Health Setting Professional Modifier TD · Registered nurse Typical Low $169.82 Median $181.97 Typical High $181.97 | Professional | TD · Registered nurse | $169.82 | $181.97 | $181.97 |
Fallon Health Setting Professional Modifier U6 · State-defined Typical Low $199.53 Median $199.53 Typical High $213.80 | Professional | U6 · State-defined | $199.53 | $199.53 | $213.80 |
Fallon Health Setting Professional Modifier UG · Afternoon Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | UG · Afternoon | $162.18 | $162.18 | $162.18 |
Fidelis Setting Professional Modifier 25 · Same-day visit Typical Low $104.71 Median $144.54 Typical High $213.80 | Professional | 25 · Same-day visit | $104.71 | $144.54 | $213.80 |
Florida Blue Setting Professional Modifier HF · Substance use program Typical Low $177.83 Median $194.98 Typical High $199.53 | Professional | HF · Substance use program | $177.83 | $194.98 | $199.53 |
Health Alliance Plan Setting Professional Modifier 25 · Same-day visit Typical Low $91.20 Median $213.80 Typical High $457.09 | Professional | 25 · Same-day visit | $91.20 | $213.80 | $457.09 |
Health Alliance Plan Setting Professional Modifier 52 · Reduced service Typical Low $69.18 Median $69.18 Typical High $85.11 | Professional | 52 · Reduced service | $69.18 | $69.18 | $85.11 |
Health Alliance Plan Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $20.42 Typical High $25.70 | Professional | 55 · Aftercare only | $20.42 | $20.42 | $25.70 |
Health Alliance Plan Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $13.80 Typical High $16.98 | Professional | 56 · Pre-op care only | $13.80 | $13.80 | $16.98 |
Health Alliance Plan Setting Professional Modifier 57 · Decision for surgery Typical Low $112.20 Median $173.78 Typical High $309.03 | Professional | 57 · Decision for surgery | $112.20 | $173.78 | $309.03 |
Health Alliance Plan Setting Professional Modifier FS · Shared visit Typical Low $131.83 Median $173.78 Typical High $194.98 | Professional | FS · Shared visit | $131.83 | $173.78 | $194.98 |
Health Alliance Plan Setting Professional Modifier GA · Liability notice issued Typical Low $158.49 Median $158.49 Typical High $158.49 | Professional | GA · Liability notice issued | $158.49 | $158.49 | $158.49 |
Health Alliance Plan Setting Professional Modifier GC · Resident with teaching physician Typical Low $138.04 Median $257.04 Typical High $316.23 | Professional | GC · Resident with teaching physician | $138.04 | $257.04 | $316.23 |
Health Alliance Plan Setting Professional Modifier GF · Non-physician, rural hospital Typical Low $380.19 Median $380.19 Typical High $380.19 | Professional | GF · Non-physician, rural hospital | $380.19 | $380.19 | $380.19 |
Highmark BCBS Setting Professional Modifier 25 · Same-day visit Typical Low $144.54 Median $186.21 Typical High $288.40 | Professional | 25 · Same-day visit | $144.54 | $186.21 | $288.40 |
Highmark BCBS Setting Professional Modifier FS · Shared visit Typical Low $131.83 Median $141.25 Typical High $181.97 | Professional | FS · Shared visit | $131.83 | $141.25 | $181.97 |
Highmark BCBS Setting Professional Modifier GC · Resident with teaching physician Typical Low $134.90 Median $199.53 Typical High $309.03 | Professional | GC · Resident with teaching physician | $134.90 | $199.53 | $309.03 |
Kaiser Permanente Setting Professional Modifier HO · Master's level Typical Low $89.13 Median $125.89 Typical High $173.78 | Professional | HO · Master's level | $89.13 | $125.89 | $173.78 |
Martin's Point Setting Facility Modifier 52 · Reduced service Typical Low $52.48 Median $63.10 Typical High $69.18 | Facility | 52 · Reduced service | $52.48 | $63.10 | $69.18 |
Martin's Point Setting Facility Modifier 55 · Aftercare only Typical Low $15.85 Median $19.05 Typical High $20.89 | Facility | 55 · Aftercare only | $15.85 | $19.05 | $20.89 |
Martin's Point Setting Facility Modifier 56 · Pre-op care only Typical Low $10.47 Median $12.59 Typical High $13.80 | Facility | 56 · Pre-op care only | $10.47 | $12.59 | $13.80 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $52.48 Median $60.26 Typical High $66.07 | Professional | 52 · Reduced service | $52.48 | $60.26 | $66.07 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $18.20 Typical High $19.50 | Professional | 55 · Aftercare only | $15.85 | $18.20 | $19.50 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $12.02 Typical High $13.18 | Professional | 56 · Pre-op care only | $10.47 | $12.02 | $13.18 |
Martin's Point Setting Professional Modifier AF · Specialist physician Typical Low $114.82 Median $169.82 Typical High $316.23 | Professional | AF · Specialist physician | $114.82 | $169.82 | $316.23 |
Martin's Point Setting Professional Modifier HO · Master's level Typical Low $85.11 Median $128.82 Typical High $239.88 | Professional | HO · Master's level | $85.11 | $128.82 | $239.88 |
Martin's Point Setting Professional Modifier TD · Registered nurse Typical Low $97.72 Median $144.54 Typical High $269.15 | Professional | TD · Registered nurse | $97.72 | $144.54 | $269.15 |
Mass General Brigham Setting Professional Modifier 25 · Same-day visit Typical Low $70.79 Median $138.04 Typical High $239.88 | Professional | 25 · Same-day visit | $70.79 | $138.04 | $239.88 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $64.57 Median $81.28 Typical High $120.23 | Professional | 51 · Multiple procedures | $64.57 | $81.28 | $120.23 |
Medcost Setting Professional Modifier 80 · Assistant surgeon Typical Low $25.70 Median $33.11 Typical High $47.86 | Professional | 80 · Assistant surgeon | $25.70 | $33.11 | $47.86 |
Medcost Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $18.20 Median $22.91 Typical High $33.11 | Professional | 81 · Minimal assistant surgeon | $18.20 | $22.91 | $33.11 |
Medcost Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $18.20 Median $22.91 Typical High $33.11 | Professional | 82 · Assistant surgeon, no resident | $18.20 | $22.91 | $33.11 |
Medcost Setting Professional Modifier 93 · Audio-only telehealth Typical Low $50.12 Median $50.12 Typical High $50.12 | Professional | 93 · Audio-only telehealth | $50.12 | $50.12 | $50.12 |
Medcost Setting Professional Modifier AS · PA/NP assist Typical Low $18.20 Median $22.91 Typical High $33.11 | Professional | AS · PA/NP assist | $18.20 | $22.91 | $33.11 |
Medcost Setting Professional Modifier FQ · Audio-only Typical Low $50.12 Median $50.12 Typical High $50.12 | Professional | FQ · Audio-only | $50.12 | $50.12 | $50.12 |
Medica Setting Professional Modifier 25 · Same-day visit Typical Low $173.78 Median $338.84 Typical High $489.78 | Professional | 25 · Same-day visit | $173.78 | $338.84 | $489.78 |
Moda Health Setting Facility Modifier 25 · Same-day visit Typical Low $144.54 Median $436.52 Typical High $933.25 | Facility | 25 · Same-day visit | $144.54 | $436.52 | $933.25 |
Moda Health Setting Facility Modifier 52 · Reduced service Typical Low $52.48 Median $64.57 Typical High $70.79 | Facility | 52 · Reduced service | $52.48 | $64.57 | $70.79 |
Moda Health Setting Facility Modifier 55 · Aftercare only Typical Low $15.85 Median $19.50 Typical High $21.38 | Facility | 55 · Aftercare only | $15.85 | $19.50 | $21.38 |
Moda Health Setting Facility Modifier 56 · Pre-op care only Typical Low $10.47 Median $12.88 Typical High $14.13 | Facility | 56 · Pre-op care only | $10.47 | $12.88 | $14.13 |
Moda Health Setting Facility Modifier AF · Specialist physician Typical Low $169.82 Median $177.83 Typical High $186.21 | Facility | AF · Specialist physician | $169.82 | $177.83 | $186.21 |
Moda Health Setting Facility Modifier HO · Master's level Typical Low $125.89 Median $131.83 Typical High $151.36 | Facility | HO · Master's level | $125.89 | $131.83 | $151.36 |
Moda Health Setting Facility Modifier TD · Registered nurse Typical Low $144.54 Median $151.36 Typical High $154.88 | Facility | TD · Registered nurse | $144.54 | $151.36 | $154.88 |
Moda Health Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $39.81 Median $144.54 Typical High $281.84 | Professional | 24 · Unrelated visit after surgery | $39.81 | $144.54 | $281.84 |
Moda Health Setting Professional Modifier 25 · Same-day visit Typical Low $100.00 Median $199.53 Typical High $457.09 | Professional | 25 · Same-day visit | $100.00 | $199.53 | $457.09 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $52.48 Median $67.61 Typical High $102.33 | Professional | 52 · Reduced service | $52.48 | $67.61 | $102.33 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $20.42 Typical High $30.90 | Professional | 55 · Aftercare only | $15.85 | $20.42 | $30.90 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $13.49 Typical High $20.42 | Professional | 56 · Pre-op care only | $10.47 | $13.49 | $20.42 |
Moda Health Setting Professional Modifier 57 · Decision for surgery Typical Low $112.20 Median $199.53 Typical High $549.54 | Professional | 57 · Decision for surgery | $112.20 | $199.53 | $549.54 |
Moda Health Setting Professional Modifier AF · Specialist physician Typical Low $114.82 Median $138.04 Typical High $190.55 | Professional | AF · Specialist physician | $114.82 | $138.04 | $190.55 |
Moda Health Setting Professional Modifier FS · Shared visit Typical Low $26.92 Median $147.91 Typical High $186.21 | Professional | FS · Shared visit | $26.92 | $147.91 | $186.21 |
Moda Health Setting Professional Modifier GC · Resident with teaching physician Typical Low $125.89 Median $263.03 Typical High $537.03 | Professional | GC · Resident with teaching physician | $125.89 | $263.03 | $537.03 |
Moda Health Setting Professional Modifier HO · Master's level Typical Low $85.11 Median $102.33 Typical High $147.91 | Professional | HO · Master's level | $85.11 | $102.33 | $147.91 |
Moda Health Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $125.89 Median $169.82 Typical High $263.03 | Professional | Q6 · Substitute physician, paid per time | $125.89 | $169.82 | $263.03 |
Moda Health Setting Professional Modifier SA · Nurse practitioner Typical Low $131.83 Median $151.36 Typical High $323.59 | Professional | SA · Nurse practitioner | $131.83 | $151.36 | $323.59 |
Moda Health Setting Professional Modifier TD · Registered nurse Typical Low $97.72 Median $117.49 Typical High $162.18 | Professional | TD · Registered nurse | $97.72 | $117.49 | $162.18 |
Moda Health Setting Professional Modifier X1 · Ongoing, broad care Typical Low $117.49 Median $295.12 Typical High $371.54 | Professional | X1 · Ongoing, broad care | $117.49 | $295.12 | $371.54 |
MountainHealth Co-op Setting Professional Modifier 54 · Surgery only Typical Low $173.78 Median $173.78 Typical High $218.78 | Professional | 54 · Surgery only | $173.78 | $173.78 | $218.78 |
MountainHealth Co-op Setting Professional Modifier 56 · Pre-op care only Typical Low $25.12 Median $25.12 Typical High $31.62 | Professional | 56 · Pre-op care only | $25.12 | $25.12 | $31.62 |
MountainHealth Co-op Setting Professional Modifier 78 · Unplanned return to OR Typical Low $186.21 Median $186.21 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $186.21 | $186.21 | $234.42 |
Qualchoice Setting Professional Modifier 25 · Same-day visit Typical Low $147.91 Median $186.21 Typical High $239.88 | Professional | 25 · Same-day visit | $147.91 | $186.21 | $239.88 |
Qualchoice Setting Professional Modifier 57 · Decision for surgery Typical Low $186.21 Median $186.21 Typical High $245.47 | Professional | 57 · Decision for surgery | $186.21 | $186.21 | $245.47 |
Qualchoice Setting Professional Modifier FS · Shared visit Typical Low $141.25 Median $194.98 Typical High $194.98 | Professional | FS · Shared visit | $141.25 | $194.98 | $194.98 |
Qualchoice Setting Professional Modifier GC · Resident with teaching physician Typical Low $186.21 Median $186.21 Typical High $269.15 | Professional | GC · Resident with teaching physician | $186.21 | $186.21 | $269.15 |
United Setting Professional Modifier G0 · Stroke telehealth Typical Low $338.84 Median $338.84 Typical High $338.84 | Professional | G0 · Stroke telehealth | $338.84 | $338.84 | $338.84 |
United Setting Professional Modifier GJ · Opt-out physician, urgent Typical Low $208.93 Median $208.93 Typical High $302.00 | Professional | GJ · Opt-out physician, urgent | $208.93 | $208.93 | $302.00 |
United Setting Professional Modifier GQ · Store-and-forward telehealth Typical Low $338.84 Median $338.84 Typical High $338.84 | Professional | GQ · Store-and-forward telehealth | $338.84 | $338.84 | $338.84 |
Well Sense Setting Facility Modifier SA · Nurse practitioner Typical Low $131.83 Median $165.96 Typical High $309.03 | Facility | SA · Nurse practitioner | $131.83 | $165.96 | $309.03 |
Well Sense Setting Facility Modifier U4 · State-defined Typical Low $218.78 Median $309.03 Typical High $524.81 | Facility | U4 · State-defined | $218.78 | $309.03 | $524.81 |
Well Sense Setting Facility Modifier U6 · State-defined Typical Low $131.83 Median $186.21 Typical High $316.23 | Facility | U6 · State-defined | $131.83 | $186.21 | $316.23 |
Well Sense Setting Facility Modifier UG · Afternoon Typical Low $138.04 Median $194.98 Typical High $338.84 | Facility | UG · Afternoon | $138.04 | $194.98 | $338.84 |
Well Sense Setting Professional Modifier GF · Non-physician, rural hospital Typical Low $77.62 Median $77.62 Typical High $93.33 | Professional | GF · Non-physician, rural hospital | $77.62 | $77.62 | $93.33 |
Well Sense Setting Professional Modifier U4 · State-defined Typical Low $257.04 Median $257.04 Typical High $309.03 | Professional | U4 · State-defined | $257.04 | $257.04 | $309.03 |
What it costs in each state
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.
Touch or drag across the chart to see any state's rate.
AK $263AL $115
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.