How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $75.86 Median $107.15 Typical High $141.25 | Facility | None | $75.86 | $107.15 | $141.25 |
Aetna Setting Professional Modifier None Typical Low $75.86 Median $123.03 Typical High $151.36 | Professional | None | $75.86 | $123.03 | $151.36 |
Ambetter Setting Professional Modifier None Typical Low $70.79 Median $104.71 Typical High $158.49 | Professional | None | $70.79 | $104.71 | $158.49 |
BCBS Tennessee Setting Professional Modifier None Typical Low $74.13 Median $97.72 Typical High $186.21 | Professional | None | $74.13 | $97.72 | $186.21 |
Cigna Setting Professional Modifier None Typical Low $77.62 Median $81.28 Typical High $169.82 | Professional | None | $77.62 | $81.28 | $169.82 |
Lucent Health Setting Professional Modifier None Typical Low $616.60 Median $616.60 Typical High $616.60 | Professional | None | $616.60 | $616.60 | $616.60 |
Optum Setting Professional Modifier None Typical Low $79.43 Median $83.18 Typical High $123.03 | Professional | None | $79.43 | $83.18 | $123.03 |
United Setting Professional Modifier None Typical Low $79.43 Median $107.15 Typical High $190.55 | Professional | None | $79.43 | $107.15 | $190.55 |
6 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 $38.02 Median $39.81 Typical High $48.98 | Professional | 52 · Reduced service | $38.02 | $39.81 | $48.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $12.02 Typical High $14.79 | Professional | 55 · Aftercare only | $11.48 | $12.02 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $7.94 Typical High $9.77 | Professional | 56 · Pre-op care only | $7.59 | $7.94 | $9.77 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $70.79 Median $83.18 Typical High $169.82 | Professional | 25 · Same-day visit | $70.79 | $83.18 | $169.82 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $70.79 Median $91.20 Typical High $173.78 | Professional | 57 · Decision for surgery | $70.79 | $91.20 | $173.78 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $70.79 Median $70.79 Typical High $154.88 | Professional | GC · Resident with teaching physician | $70.79 | $70.79 | $154.88 |
Where Tennessee 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.
Tennessee· 25th of 51
$110
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.