How much rates vary
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 $93.33 Median $104.71 Typical High $131.83 | Facility | None | $93.33 | $104.71 | $131.83 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $95.50 Typical High $131.83 | Professional | None | $85.11 | $95.50 | $131.83 |
Ambetter Setting Professional Modifier None Typical Low $97.72 Median $104.71 Typical High $128.82 | Professional | None | $97.72 | $104.71 | $128.82 |
Anthem BCBS Setting Facility Modifier None Typical Low $2,630.27 Median $2,951.21 Typical High $4,168.69 | Facility | None | $2,630.27 | $2,951.21 | $4,168.69 |
Anthem BCBS Setting Professional Modifier None Typical Low $87.10 Median $104.71 Typical High $158.49 | Professional | None | $87.10 | $104.71 | $158.49 |
CareSource Setting Facility Modifier None Typical Low $85.11 Median $114.82 Typical High $158.49 | Facility | None | $85.11 | $114.82 | $158.49 |
CareSource Setting Professional Modifier None Typical Low $109.65 Median $117.49 Typical High $147.91 | Professional | None | $109.65 | $117.49 | $147.91 |
Cigna Setting Facility Modifier None Typical Low $141.25 Median $141.25 Typical High $3,981.07 | Facility | None | $141.25 | $141.25 | $3,981.07 |
Cigna Setting Professional Modifier None Typical Low $102.33 Median $114.82 Typical High $645.65 | Professional | None | $102.33 | $114.82 | $645.65 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $75.86 | Professional | None | $33.11 | $33.11 | $75.86 |
United Setting Professional Modifier None Typical Low $97.72 Median $109.65 Typical High $158.49 | Professional | None | $97.72 | $109.65 | $158.49 |
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 Facility Modifier 52 · Reduced service Typical Low $46.77 Median $52.48 Typical High $66.07 | Facility | 52 · Reduced service | $46.77 | $52.48 | $66.07 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $14.13 Median $15.49 Typical High $19.95 | Facility | 55 · Aftercare only | $14.13 | $15.49 | $19.95 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $9.33 Median $10.47 Typical High $13.18 | Facility | 56 · Pre-op care only | $9.33 | $10.47 | $13.18 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $41.69 Median $46.77 Typical High $52.48 | Professional | 52 · Reduced service | $41.69 | $46.77 | $52.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $14.13 Typical High $15.49 | Professional | 55 · Aftercare only | $12.59 | $14.13 | $15.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $9.33 Typical High $10.47 | Professional | 56 · Pre-op care only | $8.32 | $9.33 | $10.47 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $97.72 Median $97.72 Typical High $97.72 | Professional | 25 · Same-day visit | $97.72 | $97.72 | $97.72 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | FS · Shared visit | $123.03 | $123.03 | $123.03 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | GC · Resident with teaching physician | $123.03 | $123.03 | $123.03 |
Where Kentucky 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.
Kentucky· 46th of 51
$105
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.