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 $120.23 Median $120.23 Typical High $120.23 | Facility | None | $120.23 | $120.23 | $120.23 |
Aetna Setting Professional Modifier None Typical Low $69.18 Median $91.20 Typical High $100.00 | Professional | None | $69.18 | $91.20 | $100.00 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $34.67 Median $42.66 Typical High $50.12 | Professional | 52 · Reduced service | $34.67 | $42.66 | $50.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.47 Median $12.88 Typical High $14.79 | Professional | 55 · Aftercare only | $10.47 | $12.88 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.92 Median $8.71 Typical High $10.00 | Professional | 56 · Pre-op care only | $6.92 | $8.71 | $10.00 |
Ambetter Setting Professional Modifier None Typical Low $102.33 Median $151.36 Typical High $151.36 | Professional | None | $102.33 | $151.36 | $151.36 |
Cigna Setting Professional Modifier None Typical Low $69.18 Median $74.13 Typical High $102.33 | Professional | None | $69.18 | $74.13 | $102.33 |
United Setting Professional Modifier None Typical Low $63.10 Median $87.10 Typical High $114.82 | Professional | None | $63.10 | $87.10 | $114.82 |
4 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 |
|---|---|---|---|---|---|
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $93.33 Median $109.65 Typical High $109.65 | Professional | 25 · Same-day visit | $93.33 | $109.65 | $109.65 |
Ambetter Setting Professional Modifier EP · Child screening program Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | EP · Child screening program | $109.65 | $109.65 | $109.65 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $93.33 Median $93.33 Typical High $93.33 | Professional | GE · Resident, primary care exception | $93.33 | $93.33 | $93.33 |
BCBS Alabama Setting Professional Modifier 12 + 32 · Mandated service Typical Low $81.28 Median $109.65 Typical High $144.54 | Professional | 12 + 32 · Mandated service | $81.28 | $109.65 | $144.54 |
Where Alabama sits
The same service costs 2.8 times more in Alaska than in Washington, DC. 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.
Alabama· 48th of 51
$83.18
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.