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 $87.10 Median $112.20 Typical High $117.49 | Facility | None | $87.10 | $112.20 | $117.49 |
Aetna Setting Professional Modifier None Typical Low $87.10 Median $109.65 Typical High $162.18 | Professional | None | $87.10 | $109.65 | $162.18 |
Ambetter Setting Professional Modifier None Typical Low $85.11 Median $114.82 Typical High $131.83 | Professional | None | $85.11 | $114.82 | $131.83 |
CareSource Setting Professional Modifier None Typical Low $154.88 Median $154.88 Typical High $154.88 | Professional | None | $154.88 | $154.88 | $154.88 |
Cigna Setting Professional Modifier None Typical Low $89.13 Median $97.72 Typical High $151.36 | Professional | None | $89.13 | $97.72 | $151.36 |
Qualchoice Setting Professional Modifier None Typical Low $97.72 Median $131.83 Typical High $154.88 | Professional | None | $97.72 | $131.83 | $154.88 |
United Setting Professional Modifier None Typical Low $89.13 Median $100.00 Typical High $165.96 | Professional | None | $89.13 | $100.00 | $165.96 |
8 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 $40.74 Median $56.23 Typical High $56.23 | Professional | 52 · Reduced service | $40.74 | $56.23 | $56.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $16.98 Typical High $16.98 | Professional | 55 · Aftercare only | $12.30 | $16.98 | $16.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $11.22 Typical High $11.22 | Professional | 56 · Pre-op care only | $8.13 | $11.22 | $11.22 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $100.00 Median $117.49 Typical High $131.83 | Professional | 25 · Same-day visit | $100.00 | $117.49 | $131.83 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $114.82 Median $131.83 Typical High $134.90 | Professional | FS · Shared visit | $114.82 | $131.83 | $134.90 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $117.49 Median $117.49 Typical High $131.83 | Professional | GC · Resident with teaching physician | $117.49 | $117.49 | $131.83 |
Qualchoice Setting Professional Modifier 25 · Same-day visit Typical Low $114.82 Median $134.90 Typical High $151.36 | Professional | 25 · Same-day visit | $114.82 | $134.90 | $151.36 |
Qualchoice Setting Professional Modifier GC · Resident with teaching physician Typical Low $134.90 Median $134.90 Typical High $154.88 | Professional | GC · Resident with teaching physician | $134.90 | $134.90 | $154.88 |
Where Arkansas sits
The same service costs 2.5 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· 27th of 51
$112
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.