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 $77.62 Median $77.62 Typical High $81.28 | Facility | None | $77.62 | $77.62 | $81.28 |
Aetna Setting Professional Modifier None Typical Low $67.61 Median $81.28 Typical High $128.82 | Professional | None | $67.61 | $81.28 | $128.82 |
Ambetter Setting Professional Modifier None Typical Low $66.07 Median $77.62 Typical High $91.20 | Professional | None | $66.07 | $77.62 | $91.20 |
CareSource Setting Professional Modifier None Typical Low $102.33 Median $104.71 Typical High $104.71 | Professional | None | $102.33 | $104.71 | $104.71 |
Cigna Setting Professional Modifier None Typical Low $58.88 Median $67.61 Typical High $102.33 | Professional | None | $58.88 | $67.61 | $102.33 |
Qualchoice Setting Professional Modifier None Typical Low $75.86 Median $89.13 Typical High $107.15 | Professional | None | $75.86 | $89.13 | $107.15 |
United Setting Professional Modifier None Typical Low $63.10 Median $69.18 Typical High $109.65 | Professional | None | $63.10 | $69.18 | $109.65 |
9 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 $28.18 Median $38.90 Typical High $38.90 | Professional | 52 · Reduced service | $28.18 | $38.90 | $38.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $11.75 Typical High $11.75 | Professional | 55 · Aftercare only | $8.51 | $11.75 | $11.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $7.76 Typical High $7.76 | Professional | 56 · Pre-op care only | $5.75 | $7.76 | $7.76 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $66.07 Median $72.44 Typical High $93.33 | Professional | 25 · Same-day visit | $66.07 | $72.44 | $93.33 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $77.62 Median $77.62 Typical High $93.33 | Professional | 57 · Decision for surgery | $77.62 | $77.62 | $93.33 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $91.20 Median $91.20 Typical High $95.50 | Professional | FS · Shared visit | $91.20 | $91.20 | $95.50 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $77.62 Median $77.62 Typical High $91.20 | Professional | GC · Resident with teaching physician | $77.62 | $77.62 | $91.20 |
Qualchoice Setting Professional Modifier 25 · Same-day visit Typical Low $75.86 Median $75.86 Typical High $102.33 | Professional | 25 · Same-day visit | $75.86 | $75.86 | $102.33 |
Qualchoice Setting Professional Modifier GC · Resident with teaching physician Typical Low $89.13 Median $89.13 Typical High $104.71 | Professional | GC · Resident with teaching physician | $89.13 | $89.13 | $104.71 |
Where Arkansas sits
The same service costs 2.4 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.
Arkansas· 21st of 51
$79.43
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.