How much rates vary
Facilitymedian $45 · 10th to 90th $23 to $135Professionalmedian $39 · 10th to 90th $25 to $65
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 $22.91 Median $37.15 Typical High $64.57 | Facility | None | $22.91 | $37.15 | $64.57 |
Aetna Setting Professional Modifier None Typical Low $22.91 Median $36.31 Typical High $52.48 | Professional | None | $22.91 | $36.31 | $52.48 |
Ambetter Setting Professional Modifier None Typical Low $33.88 Median $56.23 Typical High $69.18 | Professional | None | $33.88 | $56.23 | $69.18 |
BCBS Illinois Setting Facility Modifier None Typical Low $63.10 Median $125.89 Typical High $436.52 | Facility | None | $63.10 | $125.89 | $436.52 |
BCBS Illinois Setting Professional Modifier None Typical Low $34.67 Median $50.12 Typical High $64.57 | Professional | None | $34.67 | $50.12 | $64.57 |
Cigna Setting Facility Modifier None Typical Low $120.23 Median $134.90 Typical High $162.18 | Facility | None | $120.23 | $134.90 | $162.18 |
Cigna Setting Professional Modifier None Typical Low $23.99 Median $40.74 Typical High $87.10 | Professional | None | $23.99 | $40.74 | $87.10 |
Hally Health Setting Professional Modifier None Typical Low $35.48 Median $60.26 Typical High $102.33 | Professional | None | $35.48 | $60.26 | $102.33 |
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 $42.66 Median $63.10 Typical High $74.13 | Professional | None | $42.66 | $63.10 | $74.13 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
United Setting Professional Modifier None Typical Low $25.70 Median $42.66 Typical High $70.79 | Professional | None | $25.70 | $42.66 | $70.79 |
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 $12.59 Median $19.50 Typical High $24.55 | Facility | 52 · Reduced service | $12.59 | $19.50 | $24.55 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $3.80 Median $5.89 Typical High $7.41 | Facility | 55 · Aftercare only | $3.80 | $5.89 | $7.41 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $2.51 Median $3.89 Typical High $4.90 | Facility | 56 · Pre-op care only | $2.51 | $3.89 | $4.90 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $13.80 Median $17.78 Typical High $23.99 | Professional | 52 · Reduced service | $13.80 | $17.78 | $23.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.17 Median $5.37 Typical High $7.24 | Professional | 55 · Aftercare only | $4.17 | $5.37 | $7.24 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.75 Median $3.55 Typical High $4.79 | Professional | 56 · Pre-op care only | $2.75 | $3.55 | $4.79 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $57.54 Median $58.88 Typical High $67.61 | Professional | 24 · Unrelated visit after surgery | $57.54 | $58.88 | $67.61 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $30.20 Median $56.23 Typical High $67.61 | Professional | 25 · Same-day visit | $30.20 | $56.23 | $67.61 |
Ambetter Setting Professional Modifier 93 · Audio-only telehealth Typical Low $47.86 Median $63.10 Typical High $74.13 | Professional | 93 · Audio-only telehealth | $47.86 | $63.10 | $74.13 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $56.23 Median $69.18 Typical High $69.18 | Professional | GC · Resident with teaching physician | $56.23 | $69.18 | $69.18 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $40.74 Median $69.18 Typical High $74.13 | Professional | GE · Resident, primary care exception | $40.74 | $69.18 | $74.13 |
Ambetter Setting Professional Modifier U5 · State-defined Typical Low $40.74 Median $70.79 Typical High $85.11 | Professional | U5 · State-defined | $40.74 | $70.79 | $85.11 |
Where Illinois sits
The same service costs 2.4 times more in Alaska than in New Jersey. 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.
Illinois· 44th of 51
$38.90
AK $77.62NJ $32.36
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.