How much rates vary
Facilitymedian $117 · 10th to 90th $65 to $407Professionalmedian $129 · 10th to 90th $79 to $178
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 $89.13 Median $125.89 Typical High $416.87 | Facility | None | $89.13 | $125.89 | $416.87 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $114.82 Typical High $186.21 | Professional | None | $89.13 | $114.82 | $186.21 |
Ambetter Setting Professional Modifier None Typical Low $128.82 Median $154.88 Typical High $173.78 | Professional | None | $128.82 | $154.88 | $173.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $117.49 Median $141.25 Typical High $158.49 | Professional | None | $117.49 | $141.25 | $158.49 |
CDPHP Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $213.80 | Professional | None | $165.96 | $165.96 | $213.80 |
Cigna Setting Facility Modifier None Typical Low $141.25 Median $141.25 Typical High $141.25 | Facility | None | $141.25 | $141.25 | $141.25 |
Cigna Setting Professional Modifier None Typical Low $91.20 Median $120.23 Typical High $239.88 | Professional | None | $91.20 | $120.23 | $239.88 |
Emblem Health Setting Facility Modifier None Typical Low $0.10 Median $107.15 Typical High $302.00 | Facility | None | $0.10 | $107.15 | $302.00 |
Emblem Health Setting Professional Modifier None Typical Low $30.90 Median $67.61 Typical High $79.43 | Professional | None | $30.90 | $67.61 | $79.43 |
Excellus BCBS Setting Professional Modifier None Typical Low $114.82 Median $134.90 Typical High $173.78 | Professional | None | $114.82 | $134.90 | $173.78 |
Highmark BCBS Setting Facility Modifier None Typical Low $36.31 Median $123.03 Typical High $158.49 | Facility | None | $36.31 | $123.03 | $158.49 |
Highmark BCBS Setting Professional Modifier None Typical Low $190.55 Median $199.53 Typical High $275.42 | Professional | None | $190.55 | $199.53 | $275.42 |
MVP Health Care Setting Facility Modifier None Typical Low $97.72 Median $97.72 Typical High $97.72 | Facility | None | $97.72 | $97.72 | $97.72 |
MVP Health Care Setting Professional Modifier None Typical Low $79.43 Median $79.43 Typical High $208.93 | Professional | None | $79.43 | $79.43 | $208.93 |
Optum Setting Professional Modifier None Typical Low $134.90 Median $165.96 Typical High $169.82 | Professional | None | $134.90 | $165.96 | $169.82 |
United Setting Professional Modifier None Typical Low $93.33 Median $125.89 Typical High $186.21 | Professional | None | $93.33 | $125.89 | $186.21 |
Univera Setting Facility Modifier None Typical Low $64.57 Median $107.15 Typical High $588.84 | Facility | None | $64.57 | $107.15 | $588.84 |
Univera Setting Professional Modifier None Typical Low $114.82 Median $134.90 Typical High $173.78 | Professional | None | $114.82 | $134.90 | $173.78 |
6 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 $44.67 Median $57.54 Typical High $67.61 | Professional | 52 · Reduced service | $44.67 | $57.54 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.18 Median $16.98 Typical High $19.95 | Professional | 55 · Aftercare only | $13.18 | $16.98 | $19.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $11.48 Typical High $13.49 | Professional | 56 · Pre-op care only | $8.91 | $11.48 | $13.49 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $128.82 Median $151.36 Typical High $169.82 | Professional | 25 · Same-day visit | $128.82 | $151.36 | $169.82 |
Fidelis Setting Professional Modifier SA · Nurse practitioner Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | SA · Nurse practitioner | $173.78 | $173.78 | $173.78 |
Highmark BCBS Setting Professional Modifier 25 · Same-day visit Typical Low $169.82 Median $199.53 Typical High $302.00 | Professional | 25 · Same-day visit | $169.82 | $199.53 | $302.00 |
Where New York sits
The same service costs 2.7 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.
New York· 41st of 51
$129
AK $295DC $110
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.