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 $53.70 Median $61.66 Typical High $79.43 | Facility | None | $53.70 | $61.66 | $79.43 |
Aetna Setting Professional Modifier None Typical Low $53.70 Median $72.44 Typical High $131.83 | Professional | None | $53.70 | $72.44 | $131.83 |
Ambetter Setting Professional Modifier None Typical Low $70.79 Median $87.10 Typical High $91.20 | Professional | None | $70.79 | $87.10 | $91.20 |
Anthem BCBS Setting Professional Modifier None Typical Low $70.79 Median $83.18 Typical High $131.83 | Professional | None | $70.79 | $83.18 | $131.83 |
CareSource Setting Facility Modifier None Typical Low $64.57 Median $87.10 Typical High $123.03 | Facility | None | $64.57 | $87.10 | $123.03 |
CareSource Setting Professional Modifier None Typical Low $75.86 Median $85.11 Typical High $117.49 | Professional | None | $75.86 | $85.11 | $117.49 |
Cigna Setting Facility Modifier None Typical Low $104.71 Median $104.71 Typical High $104.71 | Facility | None | $104.71 | $104.71 | $104.71 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $141.25 Typical High $363.08 | Professional | None | $79.43 | $141.25 | $363.08 |
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 $83.18 Median $91.20 Typical High $158.49 | Professional | None | $83.18 | $91.20 | $158.49 |
10 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 $32.36 Median $36.31 Typical High $39.81 | Facility | 52 · Reduced service | $32.36 | $36.31 | $39.81 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $9.77 Median $10.72 Typical High $12.02 | Facility | 55 · Aftercare only | $9.77 | $10.72 | $12.02 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $6.46 Median $7.24 Typical High $7.94 | Facility | 56 · Pre-op care only | $6.46 | $7.24 | $7.94 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $31.62 Median $36.31 Typical High $39.81 | Professional | 52 · Reduced service | $31.62 | $36.31 | $39.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.55 Median $10.72 Typical High $12.02 | Professional | 55 · Aftercare only | $9.55 | $10.72 | $12.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.31 Median $7.24 Typical High $7.94 | Professional | 56 · Pre-op care only | $6.31 | $7.24 | $7.94 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $72.44 Median $77.62 Typical High $102.33 | Professional | 25 · Same-day visit | $72.44 | $77.62 | $102.33 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $91.20 Median $91.20 Typical High $91.20 | Professional | 57 · Decision for surgery | $91.20 | $91.20 | $91.20 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $61.66 Median $61.66 Typical High $91.20 | Professional | FS · Shared visit | $61.66 | $61.66 | $91.20 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $91.20 Median $91.20 Typical High $91.20 | Professional | GC · Resident with teaching physician | $91.20 | $91.20 | $91.20 |
Where Kentucky 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.
Kentucky· 43rd of 51
$87.10
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.