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 $97.72 Median $3,311.31 Typical High $12,022.64 | Facility | None | $97.72 | $3,311.31 | $12,022.64 |
Aetna Setting Professional Modifier None Typical Low $75.86 Median $100.00 Typical High $158.49 | Professional | None | $75.86 | $100.00 | $158.49 |
Ambetter Setting Professional Modifier None Typical Low $112.20 Median $131.83 Typical High $239.88 | Professional | None | $112.20 | $131.83 | $239.88 |
AvMed Setting Facility Modifier None Typical Low $95.50 Median $2,137.96 Typical High $11,748.98 | Facility | None | $95.50 | $2,137.96 | $11,748.98 |
AvMed Setting Professional Modifier None Typical Low $91.20 Median $114.82 Typical High $144.54 | Professional | None | $91.20 | $114.82 | $144.54 |
Cigna Setting Facility Modifier None Typical Low $93.33 Median $186.21 Typical High $2,691.53 | Facility | None | $93.33 | $186.21 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $70.79 Median $109.65 Typical High $213.80 | Professional | None | $70.79 | $109.65 | $213.80 |
Florida Blue Setting Facility Modifier None Typical Low $60.26 Median $134.90 Typical High $7,413.10 | Facility | None | $60.26 | $134.90 | $7,413.10 |
Florida Blue Setting Professional Modifier None Typical Low $85.11 Median $102.33 Typical High $239.88 | Professional | None | $85.11 | $102.33 | $239.88 |
Molina Setting Professional Modifier None Typical Low $83.18 Median $123.03 Typical High $245.47 | Professional | None | $83.18 | $123.03 | $245.47 |
United Setting Facility Modifier None Typical Low $398.11 Median $1,000.00 Typical High $5,623.41 | Facility | None | $398.11 | $1,000.00 | $5,623.41 |
United Setting Professional Modifier None Typical Low $70.79 Median $120.23 Typical High $229.09 | Professional | None | $70.79 | $120.23 | $229.09 |
Wellpoint Setting Professional Modifier None Typical Low $67.61 Median $107.15 Typical High $107.15 | Professional | None | $67.61 | $107.15 | $107.15 |
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 $38.02 Median $47.86 Typical High $66.07 | Professional | 52 · Reduced service | $38.02 | $47.86 | $66.07 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.14 Median $19.50 Typical High $26.30 | Professional | 53 · Discontinued | $15.14 | $19.50 | $26.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $72.44 Typical High $97.72 | Professional | 54 · Surgery only | $57.54 | $72.44 | $97.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $14.45 Typical High $19.50 | Professional | 55 · Aftercare only | $11.48 | $14.45 | $19.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $9.77 Typical High $13.18 | Professional | 56 · Pre-op care only | $7.59 | $9.77 | $13.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $53.70 Median $67.61 Typical High $91.20 | Professional | 78 · Unplanned return to OR | $53.70 | $67.61 | $91.20 |
Where Florida sits
The same service costs 3.5 times more in Wisconsin than in Kentucky. 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.
Florida· 48th of 51
$123
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.