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 $42.66 Median $42.66 Typical High $81.28 | Facility | None | $42.66 | $42.66 | $81.28 |
Aetna Setting Professional Modifier None Typical Low $35.48 Median $51.29 Typical High $81.28 | Professional | None | $35.48 | $51.29 | $81.28 |
Ambetter Setting Professional Modifier None Typical Low $41.69 Median $48.98 Typical High $60.26 | Professional | None | $41.69 | $48.98 | $60.26 |
CareSource Setting Professional Modifier None Typical Low $63.10 Median $64.57 Typical High $64.57 | Professional | None | $63.10 | $64.57 | $64.57 |
Cigna Setting Professional Modifier None Typical Low $37.15 Median $39.81 Typical High $63.10 | Professional | None | $37.15 | $39.81 | $63.10 |
Qualchoice Setting Professional Modifier None Typical Low $47.86 Median $56.23 Typical High $79.43 | Professional | None | $47.86 | $56.23 | $79.43 |
United Setting Professional Modifier None Typical Low $34.67 Median $39.81 Typical High $67.61 | Professional | None | $34.67 | $39.81 | $67.61 |
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 Professional Modifier 52 · Reduced service Typical Low $15.14 Median $20.89 Typical High $20.89 | Professional | 52 · Reduced service | $15.14 | $20.89 | $20.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.57 Median $6.31 Typical High $6.31 | Professional | 55 · Aftercare only | $4.57 | $6.31 | $6.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.02 Median $4.27 Typical High $4.27 | Professional | 56 · Pre-op care only | $3.02 | $4.27 | $4.27 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $41.69 Median $48.98 Typical High $54.95 | Professional | 25 · Same-day visit | $41.69 | $48.98 | $54.95 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $48.98 Median $48.98 Typical High $50.12 | Professional | FS · Shared visit | $48.98 | $48.98 | $50.12 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $41.69 Median $48.98 Typical High $48.98 | Professional | GC · Resident with teaching physician | $41.69 | $48.98 | $48.98 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $48.98 Median $48.98 Typical High $48.98 | Professional | Q6 · Substitute physician, paid per time | $48.98 | $48.98 | $48.98 |
Qualchoice Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $56.23 Median $56.23 Typical High $69.18 | Professional | 24 · Unrelated visit after surgery | $56.23 | $56.23 | $69.18 |
Qualchoice Setting Professional Modifier FS · Shared visit Typical Low $48.98 Median $56.23 Typical High $57.54 | Professional | FS · Shared visit | $48.98 | $56.23 | $57.54 |
Qualchoice Setting Professional Modifier GC · Resident with teaching physician Typical Low $47.86 Median $56.23 Typical High $63.10 | Professional | GC · Resident with teaching physician | $47.86 | $56.23 | $63.10 |
Where Arkansas sits
The same service costs 2.7 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.
Arkansas· 33rd of 51
$47.86
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.