How much rates vary
Facilitymedian $105 · 10th to 90th $71 to $178Professionalmedian $95 · 10th to 90th $71 to $138
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 $70.79 Median $93.33 Typical High $138.04 | Facility | None | $70.79 | $93.33 | $138.04 |
Aetna Setting Professional Modifier None Typical Low $70.79 Median $91.20 Typical High $107.15 | Professional | None | $70.79 | $91.20 | $107.15 |
Ambetter Setting Professional Modifier None Typical Low $91.20 Median $114.82 Typical High $154.88 | Professional | None | $91.20 | $114.82 | $154.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $70.79 Median $87.10 Typical High $117.49 | Professional | None | $70.79 | $87.10 | $117.49 |
CareSource Setting Facility Modifier None Typical Low $79.43 Median $114.82 Typical High $204.17 | Facility | None | $79.43 | $114.82 | $204.17 |
CareSource Setting Professional Modifier None Typical Low $107.15 Median $109.65 Typical High $141.25 | Professional | None | $107.15 | $109.65 | $141.25 |
Cigna Setting Facility Modifier None Typical Low $104.71 Median $104.71 Typical High $104.71 | Facility | None | $104.71 | $104.71 | $104.71 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $109.65 Typical High $588.84 | Professional | None | $75.86 | $109.65 | $588.84 |
Molina Setting Professional Modifier None Typical Low $70.79 Median $85.11 Typical High $89.13 | Professional | None | $70.79 | $85.11 | $89.13 |
United Setting Professional Modifier None Typical Low $70.79 Median $91.20 Typical High $123.03 | Professional | None | $70.79 | $91.20 | $123.03 |
10 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 $35.48 Median $46.77 Typical High $56.23 | Facility | 52 · Reduced service | $35.48 | $46.77 | $56.23 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $10.47 Median $14.13 Typical High $16.60 | Facility | 55 · Aftercare only | $10.47 | $14.13 | $16.60 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $7.08 Median $9.33 Typical High $11.22 | Facility | 56 · Pre-op care only | $7.08 | $9.33 | $11.22 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $35.48 Median $44.67 Typical High $53.70 | Professional | 52 · Reduced service | $35.48 | $44.67 | $53.70 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.47 Median $13.49 Typical High $16.22 | Professional | 55 · Aftercare only | $10.47 | $13.49 | $16.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.08 Median $9.12 Typical High $10.72 | Professional | 56 · Pre-op care only | $7.08 | $9.12 | $10.72 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $97.72 Median $123.03 Typical High $173.78 | Professional | 25 · Same-day visit | $97.72 | $123.03 | $173.78 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | 57 · Decision for surgery | $123.03 | $123.03 | $123.03 |
Ambetter Setting Professional Modifier EP · Child screening program Typical Low $117.49 Median $117.49 Typical High $117.49 | Professional | EP · Child screening program | $117.49 | $117.49 | $117.49 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $144.54 Median $144.54 Typical High $144.54 | Professional | GC · Resident with teaching physician | $144.54 | $144.54 | $144.54 |
Where Kentucky 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.
Kentucky· 43rd of 51
$95.50
AK $224DC $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.