How much rates vary
Facilitymedian $65 · 10th to 90th $28 to $123Professionalmedian $40 · 10th to 90th $23 to $71
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 $27.54 Median $57.54 Typical High $117.49 | Facility | None | $27.54 | $57.54 | $117.49 |
Aetna Setting Professional Modifier None Typical Low $20.42 Median $33.11 Typical High $57.54 | Professional | None | $20.42 | $33.11 | $57.54 |
Ambetter Setting Professional Modifier None Typical Low $30.20 Median $47.86 Typical High $67.61 | Professional | None | $30.20 | $47.86 | $67.61 |
Anthem BCBS Setting Professional Modifier None Typical Low $22.39 Median $33.88 Typical High $50.12 | Professional | None | $22.39 | $33.88 | $50.12 |
Aultcare Setting Professional Modifier None Typical Low $30.90 Median $56.23 Typical High $74.13 | Professional | None | $30.90 | $56.23 | $74.13 |
CareSource Setting Facility Modifier None Typical Low $44.67 Median $44.67 Typical High $44.67 | Facility | None | $44.67 | $44.67 | $44.67 |
CareSource Setting Professional Modifier None Typical Low $51.29 Median $54.95 Typical High $81.28 | Professional | None | $51.29 | $54.95 | $81.28 |
Cigna Setting Facility Modifier None Typical Low $89.13 Median $128.82 Typical High $181.97 | Facility | None | $89.13 | $128.82 | $181.97 |
Cigna Setting Professional Modifier None Typical Low $23.44 Median $39.81 Typical High $66.07 | Professional | None | $23.44 | $39.81 | $66.07 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $36.31 Median $120.23 Typical High $186.21 | Facility | None | $36.31 | $120.23 | $186.21 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $23.99 Median $47.86 Typical High $81.28 | Professional | None | $23.99 | $47.86 | $81.28 |
Molina Setting Professional Modifier None Typical Low $31.62 Median $63.10 Typical High $95.50 | Professional | None | $31.62 | $63.10 | $95.50 |
Optum Setting Professional Modifier None Typical Low $47.86 Median $57.54 Typical High $57.54 | Professional | None | $47.86 | $57.54 | $57.54 |
SummaCare Setting Professional Modifier None Typical Low $32.36 Median $43.65 Typical High $70.79 | Professional | None | $32.36 | $43.65 | $70.79 |
United Setting Professional Modifier None Typical Low $20.89 Median $34.67 Typical High $57.54 | Professional | None | $20.89 | $34.67 | $57.54 |
21 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 $13.80 Median $21.88 Typical High $25.12 | Facility | 52 · Reduced service | $13.80 | $21.88 | $25.12 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $4.17 Median $6.46 Typical High $7.59 | Facility | 55 · Aftercare only | $4.17 | $6.46 | $7.59 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $2.75 Median $4.37 Typical High $5.01 | Facility | 56 · Pre-op care only | $2.75 | $4.37 | $5.01 |
Aetna Setting Facility Modifier AF · Specialist physician Typical Low $27.54 Median $34.67 Typical High $44.67 | Facility | AF · Specialist physician | $27.54 | $34.67 | $44.67 |
Aetna Setting Facility Modifier HO · Master's level Typical Low $20.42 Median $25.70 Typical High $33.88 | Facility | HO · Master's level | $20.42 | $25.70 | $33.88 |
Aetna Setting Facility Modifier TD · Registered nurse Typical Low $23.44 Median $29.51 Typical High $38.02 | Facility | TD · Registered nurse | $23.44 | $29.51 | $38.02 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $13.80 Median $21.88 Typical High $21.88 | Professional | 52 · Reduced service | $13.80 | $21.88 | $21.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.17 Median $6.46 Typical High $6.61 | Professional | 55 · Aftercare only | $4.17 | $6.46 | $6.61 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.75 Median $4.37 Typical High $4.37 | Professional | 56 · Pre-op care only | $2.75 | $4.37 | $4.37 |
Aetna Setting Professional Modifier AF · Specialist physician Typical Low $27.54 Median $34.67 Typical High $66.07 | Professional | AF · Specialist physician | $27.54 | $34.67 | $66.07 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $67.61 Median $67.61 Typical High $67.61 | Professional | 24 · Unrelated visit after surgery | $67.61 | $67.61 | $67.61 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $42.66 Median $56.23 Typical High $70.79 | Professional | 25 · Same-day visit | $42.66 | $56.23 | $70.79 |
Ambetter Setting Professional Modifier 93 · Audio-only telehealth Typical Low $39.81 Median $56.23 Typical High $64.57 | Professional | 93 · Audio-only telehealth | $39.81 | $56.23 | $64.57 |
Ambetter Setting Professional Modifier AQ · Shortage area physician Typical Low $32.36 Median $32.36 Typical High $32.36 | Professional | AQ · Shortage area physician | $32.36 | $32.36 | $32.36 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $30.90 Median $56.23 Typical High $70.79 | Professional | GC · Resident with teaching physician | $30.90 | $56.23 | $70.79 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $56.23 Median $56.23 Typical High $87.10 | Professional | GE · Resident, primary care exception | $56.23 | $56.23 | $87.10 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | KX · Policy requirements met | $25.70 | $25.70 | $25.70 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $25.70 Median $47.86 Typical High $56.23 | Professional | SA · Nurse practitioner | $25.70 | $47.86 | $56.23 |
Ambetter Setting Professional Modifier SB · Nurse midwife Typical Low $52.48 Median $67.61 Typical High $67.61 | Professional | SB · Nurse midwife | $52.48 | $67.61 | $67.61 |
Ambetter Setting Professional Modifier TH · Pregnancy care Typical Low $70.79 Median $70.79 Typical High $70.79 | Professional | TH · Pregnancy care | $70.79 | $70.79 | $70.79 |
Ambetter Setting Professional Modifier UD · State-defined Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | UD · State-defined | $60.26 | $60.26 | $60.26 |
Where Ohio 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.
Ohio· 40th of 51
$39.81
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.