How much rates vary
Facilitymedian $79 · 10th to 90th $39 to $129Professionalmedian $45 · 10th to 90th $33 to $76
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 $38.90 Median $79.43 Typical High $128.82 | Facility | None | $38.90 | $79.43 | $128.82 |
Aetna Setting Professional Modifier None Typical Low $28.84 Median $38.90 Typical High $93.33 | Professional | None | $28.84 | $38.90 | $93.33 |
Ambetter Setting Professional Modifier None Typical Low $37.15 Median $44.67 Typical High $61.66 | Professional | None | $37.15 | $44.67 | $61.66 |
Anthem BCBS Setting Professional Modifier None Typical Low $30.20 Median $40.74 Typical High $60.26 | Professional | None | $30.20 | $40.74 | $60.26 |
Aultcare Setting Professional Modifier None Typical Low $47.86 Median $50.12 Typical High $67.61 | Professional | None | $47.86 | $50.12 | $67.61 |
CareSource Setting Professional Modifier None Typical Low $45.71 Median $63.10 Typical High $75.86 | Professional | None | $45.71 | $63.10 | $75.86 |
Cigna Setting Professional Modifier None Typical Low $35.48 Median $46.77 Typical High $77.62 | Professional | None | $35.48 | $46.77 | $77.62 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $36.31 Median $56.23 Typical High $95.50 | Professional | None | $36.31 | $56.23 | $95.50 |
Molina Setting Professional Modifier None Typical Low $28.18 Median $41.69 Typical High $56.23 | Professional | None | $28.18 | $41.69 | $56.23 |
Optum Setting Professional Modifier None Typical Low $50.12 Median $50.12 Typical High $61.66 | Professional | None | $50.12 | $50.12 | $61.66 |
SummaCare Setting Professional Modifier None Typical Low $37.15 Median $52.48 Typical High $72.44 | Professional | None | $37.15 | $52.48 | $72.44 |
United Setting Professional Modifier None Typical Low $32.36 Median $42.66 Typical High $79.43 | Professional | None | $32.36 | $42.66 | $79.43 |
12 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 $19.50 Median $19.50 Typical High $44.67 | Facility | 52 · Reduced service | $19.50 | $19.50 | $44.67 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $5.75 Median $5.75 Typical High $13.49 | Facility | 55 · Aftercare only | $5.75 | $5.75 | $13.49 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $3.89 Median $3.89 Typical High $8.91 | Facility | 56 · Pre-op care only | $3.89 | $3.89 | $8.91 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $19.50 Median $19.50 Typical High $50.12 | Professional | 52 · Reduced service | $19.50 | $19.50 | $50.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.75 Median $5.75 Typical High $15.14 | Professional | 55 · Aftercare only | $5.75 | $5.75 | $15.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.89 Median $3.89 Typical High $10.00 | Professional | 56 · Pre-op care only | $3.89 | $3.89 | $10.00 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $47.86 Median $52.48 Typical High $61.66 | Professional | 24 · Unrelated visit after surgery | $47.86 | $52.48 | $61.66 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $37.15 Median $43.65 Typical High $43.65 | Professional | 25 · Same-day visit | $37.15 | $43.65 | $43.65 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $43.65 Median $43.65 Typical High $43.65 | Professional | 57 · Decision for surgery | $43.65 | $43.65 | $43.65 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $43.65 Median $45.71 Typical High $89.13 | Professional | FS · Shared visit | $43.65 | $45.71 | $89.13 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $43.65 Median $47.86 Typical High $61.66 | Professional | GC · Resident with teaching physician | $43.65 | $47.86 | $61.66 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $37.15 Median $37.15 Typical High $52.48 | Professional | SA · Nurse practitioner | $37.15 | $37.15 | $52.48 |
Where Ohio 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.
Ohio· 41st of 51
$44.67
AK $100NJ $37.15
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.