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 $107.15 Median $147.91 Typical High $229.09 | Facility | None | $107.15 | $147.91 | $229.09 |
Aetna Setting Professional Modifier None Typical Low $107.15 Median $141.25 Typical High $186.21 | Professional | None | $107.15 | $141.25 | $186.21 |
Ambetter Setting Professional Modifier None Typical Low $112.20 Median $158.49 Typical High $199.53 | Professional | None | $112.20 | $158.49 | $199.53 |
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 |
Cigna Setting Facility Modifier None Typical Low $109.65 Median $125.89 Typical High $134.90 | Facility | None | $109.65 | $125.89 | $134.90 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $141.25 Typical High $169.82 | Professional | None | $117.49 | $141.25 | $169.82 |
Medica Setting Facility Modifier None Typical Low $117.49 Median $186.21 Typical High $229.09 | Facility | None | $117.49 | $186.21 | $229.09 |
Medica Setting Professional Modifier None Typical Low $138.04 Median $831.76 Typical High $1,047.13 | Professional | None | $138.04 | $831.76 | $1,047.13 |
United Setting Professional Modifier None Typical Low $104.71 Median $138.04 Typical High $173.78 | Professional | None | $104.71 | $138.04 | $173.78 |
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 $53.70 Median $64.57 Typical High $66.07 | Professional | 52 · Reduced service | $53.70 | $64.57 | $66.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $19.50 Typical High $19.95 | Professional | 55 · Aftercare only | $15.85 | $19.50 | $19.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.72 Median $12.88 Typical High $13.18 | Professional | 56 · Pre-op care only | $10.72 | $12.88 | $13.18 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | 24 · Unrelated visit after surgery | $173.78 | $173.78 | $173.78 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $134.90 Median $165.96 Typical High $218.78 | Professional | 25 · Same-day visit | $134.90 | $165.96 | $218.78 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $95.50 Median $100.00 Typical High $100.00 | Professional | 57 · Decision for surgery | $95.50 | $100.00 | $100.00 |
Ambetter Setting Professional Modifier CG · Policy criteria applied Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | CG · Policy criteria applied | $162.18 | $162.18 | $162.18 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $208.93 Median $208.93 Typical High $295.12 | Professional | GC · Resident with teaching physician | $208.93 | $208.93 | $295.12 |
Medica Setting Professional Modifier 25 · Same-day visit Typical Low $138.04 Median $165.96 Typical High $213.80 | Professional | 25 · Same-day visit | $138.04 | $165.96 | $213.80 |
Where Oklahoma 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.
Oklahoma· 22nd of 51
$158
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.