How much rates vary
Facilitymedian $123 · 10th to 90th $91 to $170Professionalmedian $126 · 10th to 90th $91 to $209
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 $91.20 Median $117.49 Typical High $158.49 | Facility | None | $91.20 | $117.49 | $158.49 |
Aetna Setting Professional Modifier None Typical Low $87.10 Median $117.49 Typical High $154.88 | Professional | None | $87.10 | $117.49 | $154.88 |
Ambetter Setting Professional Modifier None Typical Low $117.49 Median $177.83 Typical High $251.19 | Professional | None | $117.49 | $177.83 | $251.19 |
Anthem BCBS Setting Professional Modifier None Typical Low $91.20 Median $114.82 Typical High $165.96 | Professional | None | $91.20 | $114.82 | $165.96 |
CareSource Setting Facility Modifier None Typical Low $100.00 Median $125.89 Typical High $173.78 | Facility | None | $100.00 | $125.89 | $173.78 |
CareSource Setting Professional Modifier None Typical Low $154.88 Median $158.49 Typical High $199.53 | Professional | None | $154.88 | $158.49 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $85.11 Median $190.55 Typical High $190.55 | Facility | None | $85.11 | $190.55 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $151.36 Typical High $851.14 | Professional | None | $117.49 | $151.36 | $851.14 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $112.20 | Professional | None | $33.11 | $33.11 | $112.20 |
United Setting Professional Modifier None Typical Low $107.15 Median $134.90 Typical High $177.83 | Professional | None | $107.15 | $134.90 | $177.83 |
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 $57.54 Median $64.57 Typical High $72.44 | Facility | 52 · Reduced service | $57.54 | $64.57 | $72.44 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $17.38 Median $19.50 Typical High $21.88 | Facility | 55 · Aftercare only | $17.38 | $19.50 | $21.88 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $11.75 Median $12.88 Typical High $14.45 | Facility | 56 · Pre-op care only | $11.75 | $12.88 | $14.45 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $52.48 Median $60.26 Typical High $72.44 | Professional | 52 · Reduced service | $52.48 | $60.26 | $72.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $18.20 Typical High $21.88 | Professional | 55 · Aftercare only | $15.49 | $18.20 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $12.02 Typical High $14.45 | Professional | 56 · Pre-op care only | $10.47 | $12.02 | $14.45 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $141.25 Median $177.83 Typical High $234.42 | Professional | 25 · Same-day visit | $141.25 | $177.83 | $234.42 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $120.23 Median $144.54 Typical High $165.96 | Professional | 57 · Decision for surgery | $120.23 | $144.54 | $165.96 |
Ambetter Setting Professional Modifier AM · Physician, team member Typical Low $125.89 Median $125.89 Typical High $165.96 | Professional | AM · Physician, team member | $125.89 | $125.89 | $165.96 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $141.25 Median $144.54 Typical High $208.93 | Professional | GC · Resident with teaching physician | $141.25 | $144.54 | $208.93 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $169.82 Median $169.82 Typical High $169.82 | Professional | Q6 · Substitute physician, paid per time | $169.82 | $169.82 | $169.82 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $141.25 Median $141.25 Typical High $144.54 | Professional | SA · Nurse practitioner | $141.25 | $141.25 | $144.54 |
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· 49th of 51
$126
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.