How much rates vary
Facilitymedian $50 · 10th to 90th $29 to $191Professionalmedian $43 · 10th to 90th $21 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 $28.18 Median $42.66 Typical High $50.12 | Facility | None | $28.18 | $42.66 | $50.12 |
Aetna Setting Professional Modifier None Typical Low $28.84 Median $42.66 Typical High $51.29 | Professional | None | $28.84 | $42.66 | $51.29 |
Ambetter Setting Professional Modifier None Typical Low $25.70 Median $48.98 Typical High $63.10 | Professional | None | $25.70 | $48.98 | $63.10 |
BCBS Texas Setting Facility Modifier None Typical Low $28.18 Median $70.79 Typical High $165.96 | Facility | None | $28.18 | $70.79 | $165.96 |
BCBS Texas Setting Professional Modifier None Typical Low $21.38 Median $37.15 Typical High $54.95 | Professional | None | $21.38 | $37.15 | $54.95 |
Baylor Scott & White Setting Professional Modifier None Typical Low $30.90 Median $48.98 Typical High $72.44 | Professional | None | $30.90 | $48.98 | $72.44 |
Christus Setting Facility Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Facility | None | $38.02 | $38.02 | $38.02 |
Cigna Setting Facility Modifier None Typical Low $125.89 Median $151.36 Typical High $218.78 | Facility | None | $125.89 | $151.36 | $218.78 |
Cigna Setting Professional Modifier None Typical Low $28.84 Median $41.69 Typical High $60.26 | Professional | None | $28.84 | $41.69 | $60.26 |
Health Smart Setting Facility Modifier None Typical Low $40.74 Median $44.67 Typical High $47.86 | Facility | None | $40.74 | $44.67 | $47.86 |
Health Smart Setting Professional Modifier None Typical Low $40.74 Median $66.07 Typical High $131.83 | Professional | None | $40.74 | $66.07 | $131.83 |
Lucent Health Setting Professional Modifier None Typical Low $66.07 Median $354.81 Typical High $354.81 | Professional | None | $66.07 | $354.81 | $354.81 |
Moda Health Setting Facility Modifier None Typical Low $28.84 Median $63.10 Typical High $426.58 | Facility | None | $28.84 | $63.10 | $426.58 |
Moda Health Setting Professional Modifier None Typical Low $28.84 Median $42.66 Typical High $54.95 | Professional | None | $28.84 | $42.66 | $54.95 |
Molina Setting Professional Modifier None Typical Low $9.77 Median $53.70 Typical High $72.44 | Professional | None | $9.77 | $53.70 | $72.44 |
Oscar Health Setting Professional Modifier None Typical Low $35.48 Median $61.66 Typical High $125.89 | Professional | None | $35.48 | $61.66 | $125.89 |
Providence Setting Facility Modifier None Typical Low $30.90 Median $64.57 Typical High $173.78 | Facility | None | $30.90 | $64.57 | $173.78 |
Providence Setting Professional Modifier None Typical Low $28.84 Median $41.69 Typical High $58.88 | Professional | None | $28.84 | $41.69 | $58.88 |
United Setting Facility Modifier None Typical Low $48.98 Median $48.98 Typical High $48.98 | Facility | None | $48.98 | $48.98 | $48.98 |
United Setting Professional Modifier None Typical Low $20.89 Median $34.67 Typical High $54.95 | Professional | None | $20.89 | $34.67 | $54.95 |
Wellpoint Setting Professional Modifier None Typical Low $58.88 Median $58.88 Typical High $58.88 | Professional | None | $58.88 | $58.88 | $58.88 |
40 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 $14.13 Median $16.60 Typical High $23.44 | Facility | 52 · Reduced service | $14.13 | $16.60 | $23.44 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $4.27 Median $5.01 Typical High $7.08 | Facility | 55 · Aftercare only | $4.27 | $5.01 | $7.08 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $2.82 Median $3.31 Typical High $4.68 | Facility | 56 · Pre-op care only | $2.82 | $3.31 | $4.68 |
Aetna Setting Facility Modifier AF · Specialist physician Typical Low $50.12 Median $50.12 Typical High $51.29 | Facility | AF · Specialist physician | $50.12 | $50.12 | $51.29 |
Aetna Setting Facility Modifier HO · Master's level Typical Low $37.15 Median $37.15 Typical High $38.02 | Facility | HO · Master's level | $37.15 | $37.15 | $38.02 |
Aetna Setting Facility Modifier TD · Registered nurse Typical Low $42.66 Median $42.66 Typical High $43.65 | Facility | TD · Registered nurse | $42.66 | $42.66 | $43.65 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $14.13 Median $21.88 Typical High $23.44 | Professional | 52 · Reduced service | $14.13 | $21.88 | $23.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.27 Median $6.46 Typical High $7.08 | Professional | 55 · Aftercare only | $4.27 | $6.46 | $7.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.82 Median $4.37 Typical High $4.68 | Professional | 56 · Pre-op care only | $2.82 | $4.37 | $4.68 |
Aetna Setting Professional Modifier AF · Specialist physician Typical Low $32.36 Median $42.66 Typical High $57.54 | Professional | AF · Specialist physician | $32.36 | $42.66 | $57.54 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $41.69 Median $57.54 Typical High $57.54 | Professional | 24 · Unrelated visit after surgery | $41.69 | $57.54 | $57.54 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $30.90 Median $57.54 Typical High $61.66 | Professional | 25 · Same-day visit | $30.90 | $57.54 | $61.66 |
Ambetter Setting Professional Modifier 93 · Audio-only telehealth Typical Low $25.70 Median $30.90 Typical High $32.36 | Professional | 93 · Audio-only telehealth | $25.70 | $30.90 | $32.36 |
Ambetter Setting Professional Modifier AF · Specialist physician Typical Low $57.54 Median $57.54 Typical High $57.54 | Professional | AF · Specialist physician | $57.54 | $57.54 | $57.54 |
Ambetter Setting Professional Modifier FQ · Audio-only Typical Low $26.92 Median $26.92 Typical High $26.92 | Professional | FQ · Audio-only | $26.92 | $26.92 | $26.92 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $30.90 Median $66.07 Typical High $66.07 | Professional | GC · Resident with teaching physician | $30.90 | $66.07 | $66.07 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $39.81 Median $39.81 Typical High $58.88 | Professional | GE · Resident, primary care exception | $39.81 | $39.81 | $58.88 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $41.69 Median $41.69 Typical High $41.69 | Professional | Q6 · Substitute physician, paid per time | $41.69 | $41.69 | $41.69 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $21.38 Median $57.54 Typical High $61.66 | Professional | SA · Nurse practitioner | $21.38 | $57.54 | $61.66 |
Ambetter Setting Professional Modifier U1 · State-defined Typical Low $57.54 Median $57.54 Typical High $57.54 | Professional | U1 · State-defined | $57.54 | $57.54 | $57.54 |
Ambetter Setting Professional Modifier U7 · State-defined Typical Low $25.70 Median $35.48 Typical High $61.66 | Professional | U7 · State-defined | $25.70 | $35.48 | $61.66 |
Ambetter Setting Professional Modifier UD · State-defined Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | UD · State-defined | $25.70 | $25.70 | $25.70 |
Moda Health Setting Facility Modifier 25 · Same-day visit Typical Low $85.11 Median $190.55 Typical High $398.11 | Facility | 25 · Same-day visit | $85.11 | $190.55 | $398.11 |
Moda Health Setting Facility Modifier 52 · Reduced service Typical Low $14.13 Median $16.60 Typical High $23.44 | Facility | 52 · Reduced service | $14.13 | $16.60 | $23.44 |
Moda Health Setting Facility Modifier 55 · Aftercare only Typical Low $4.27 Median $5.01 Typical High $7.08 | Facility | 55 · Aftercare only | $4.27 | $5.01 | $7.08 |
Moda Health Setting Facility Modifier 56 · Pre-op care only Typical Low $2.82 Median $3.31 Typical High $4.68 | Facility | 56 · Pre-op care only | $2.82 | $3.31 | $4.68 |
Moda Health Setting Facility Modifier AF · Specialist physician Typical Low $50.12 Median $50.12 Typical High $51.29 | Facility | AF · Specialist physician | $50.12 | $50.12 | $51.29 |
Moda Health Setting Facility Modifier HO · Master's level Typical Low $37.15 Median $37.15 Typical High $38.02 | Facility | HO · Master's level | $37.15 | $37.15 | $38.02 |
Moda Health Setting Facility Modifier TD · Registered nurse Typical Low $42.66 Median $42.66 Typical High $43.65 | Facility | TD · Registered nurse | $42.66 | $42.66 | $43.65 |
Moda Health Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $38.90 Median $61.66 Typical High $165.96 | Professional | 24 · Unrelated visit after surgery | $38.90 | $61.66 | $165.96 |
Moda Health Setting Professional Modifier 25 · Same-day visit Typical Low $30.20 Median $54.95 Typical High $97.72 | Professional | 25 · Same-day visit | $30.20 | $54.95 | $97.72 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $14.13 Median $21.38 Typical High $23.44 | Professional | 52 · Reduced service | $14.13 | $21.38 | $23.44 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $4.27 Median $6.46 Typical High $7.08 | Professional | 55 · Aftercare only | $4.27 | $6.46 | $7.08 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $2.82 Median $4.37 Typical High $4.68 | Professional | 56 · Pre-op care only | $2.82 | $4.37 | $4.68 |
Moda Health Setting Professional Modifier AF · Specialist physician Typical Low $41.69 Median $41.69 Typical High $51.29 | Professional | AF · Specialist physician | $41.69 | $41.69 | $51.29 |
Moda Health Setting Professional Modifier CG · Policy criteria applied Typical Low $63.10 Median $63.10 Typical High $63.10 | Professional | CG · Policy criteria applied | $63.10 | $63.10 | $63.10 |
Moda Health Setting Professional Modifier GE · Resident, primary care exception Typical Low $53.70 Median $53.70 Typical High $53.70 | Professional | GE · Resident, primary care exception | $53.70 | $53.70 | $53.70 |
Moda Health Setting Professional Modifier SA · Nurse practitioner Typical Low $63.10 Median $100.00 Typical High $100.00 | Professional | SA · Nurse practitioner | $63.10 | $100.00 | $100.00 |
United Setting Professional Modifier G0 · Stroke telehealth Typical Low $89.13 Median $89.13 Typical High $89.13 | Professional | G0 · Stroke telehealth | $89.13 | $89.13 | $89.13 |
United Setting Professional Modifier GQ · Store-and-forward telehealth Typical Low $89.13 Median $89.13 Typical High $89.13 | Professional | GQ · Store-and-forward telehealth | $89.13 | $89.13 | $89.13 |
Where Texas 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.
Texas· 30th of 51
$42.66
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.