How much rates vary
Facilitymedian $47 · 10th to 90th $27 to $186Professionalmedian $42 · 10th to 90th $25 to $62
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 $26.92 Median $41.69 Typical High $97.72 | Facility | None | $26.92 | $41.69 | $97.72 |
Aetna Setting Professional Modifier None Typical Low $18.62 Median $41.69 Typical High $54.95 | Professional | None | $18.62 | $41.69 | $54.95 |
Ambetter Setting Professional Modifier None Typical Low $27.54 Median $56.23 Typical High $66.07 | Professional | None | $27.54 | $56.23 | $66.07 |
Anthem BCBS Setting Facility Modifier None Typical Low $302.00 Median $363.08 Typical High $426.58 | Facility | None | $302.00 | $363.08 | $426.58 |
Anthem BCBS Setting Professional Modifier None Typical Low $34.67 Median $41.69 Typical High $64.57 | Professional | None | $34.67 | $41.69 | $64.57 |
CDPHP Setting Professional Modifier None Typical Low $51.29 Median $51.29 Typical High $79.43 | Professional | None | $51.29 | $51.29 | $79.43 |
Cigna Setting Facility Modifier None Typical Low $109.65 Median $151.36 Typical High $263.03 | Facility | None | $109.65 | $151.36 | $263.03 |
Cigna Setting Professional Modifier None Typical Low $19.95 Median $35.48 Typical High $69.18 | Professional | None | $19.95 | $35.48 | $69.18 |
Emblem Health Setting Facility Modifier None Typical Low $0.10 Median $37.15 Typical High $79.43 | Facility | None | $0.10 | $37.15 | $79.43 |
Emblem Health Setting Professional Modifier None Typical Low $30.90 Median $42.66 Typical High $42.66 | Professional | None | $30.90 | $42.66 | $42.66 |
Excellus BCBS Setting Facility Modifier None Typical Low $35.48 Median $35.48 Typical High $52.48 | Facility | None | $35.48 | $35.48 | $52.48 |
Excellus BCBS Setting Professional Modifier None Typical Low $37.15 Median $48.98 Typical High $63.10 | Professional | None | $37.15 | $48.98 | $63.10 |
Fidelis Setting Professional Modifier None Typical Low $30.20 Median $54.95 Typical High $70.79 | Professional | None | $30.20 | $54.95 | $70.79 |
Highmark BCBS Setting Facility Modifier None Typical Low $48.98 Median $186.21 Typical High $295.12 | Facility | None | $48.98 | $186.21 | $295.12 |
Highmark BCBS Setting Professional Modifier None Typical Low $36.31 Median $57.54 Typical High $89.13 | Professional | None | $36.31 | $57.54 | $89.13 |
MVP Health Care Setting Facility Modifier None Typical Low $24.55 Median $24.55 Typical High $239.88 | Facility | None | $24.55 | $24.55 | $239.88 |
MVP Health Care Setting Professional Modifier None Typical Low $30.20 Median $30.20 Typical High $66.07 | Professional | None | $30.20 | $30.20 | $66.07 |
Optum Setting Professional Modifier None Typical Low $48.98 Median $63.10 Typical High $63.10 | Professional | None | $48.98 | $63.10 | $63.10 |
United Setting Professional Modifier None Typical Low $21.38 Median $35.48 Typical High $60.26 | Professional | None | $21.38 | $35.48 | $60.26 |
Univera Setting Facility Modifier None Typical Low $12.30 Median $35.48 Typical High $162.18 | Facility | None | $12.30 | $35.48 | $162.18 |
Univera Setting Professional Modifier None Typical Low $37.15 Median $48.98 Typical High $61.66 | Professional | None | $37.15 | $48.98 | $61.66 |
11 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 $9.33 Median $16.22 Typical High $20.89 | Professional | 52 · Reduced service | $9.33 | $16.22 | $20.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.75 Median $4.79 Typical High $6.31 | Professional | 55 · Aftercare only | $2.75 | $4.79 | $6.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.86 Median $3.24 Typical High $4.17 | Professional | 56 · Pre-op care only | $1.86 | $3.24 | $4.17 |
Aetna Setting Professional Modifier AF · Specialist physician Typical Low $34.67 Median $45.71 Typical High $57.54 | Professional | AF · Specialist physician | $34.67 | $45.71 | $57.54 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $33.11 Median $56.23 Typical High $66.07 | Professional | 25 · Same-day visit | $33.11 | $56.23 | $66.07 |
Ambetter Setting Professional Modifier 93 · Audio-only telehealth Typical Low $30.90 Median $56.23 Typical High $66.07 | Professional | 93 · Audio-only telehealth | $30.90 | $56.23 | $66.07 |
Emblem Health Setting Professional Modifier GQ · Store-and-forward telehealth Typical Low $38.02 Median $40.74 Typical High $40.74 | Professional | GQ · Store-and-forward telehealth | $38.02 | $40.74 | $40.74 |
Emblem Health Setting Professional Modifier HE · Mental health program Typical Low $38.90 Median $38.90 Typical High $38.90 | Professional | HE · Mental health program | $38.90 | $38.90 | $38.90 |
Emblem Health Setting Professional Modifier HG · Opioid treatment program Typical Low $38.90 Median $38.90 Typical High $38.90 | Professional | HG · Opioid treatment program | $38.90 | $38.90 | $38.90 |
Fidelis Setting Professional Modifier 25 · Same-day visit Typical Low $38.02 Median $54.95 Typical High $72.44 | Professional | 25 · Same-day visit | $38.02 | $54.95 | $72.44 |
Highmark BCBS Setting Professional Modifier 25 · Same-day visit Typical Low $48.98 Median $57.54 Typical High $89.13 | Professional | 25 · Same-day visit | $48.98 | $57.54 | $89.13 |
Where New York 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.
New York· 31st of 51
$41.69
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.