How much rates vary
Facilitymedian $813 · 10th to 90th $339 to $4,677Professionalmedian $182 · 10th to 90th $78 to $309
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 $354.81 Median $3,019.95 Typical High $10,964.78 | Facility | None | $354.81 | $3,019.95 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $97.72 Median $199.53 Typical High $309.03 | Professional | None | $97.72 | $199.53 | $309.03 |
Ambetter Setting Professional Modifier None Typical Low $91.20 Median $194.98 Typical High $275.42 | Professional | None | $91.20 | $194.98 | $275.42 |
AvMed Setting Facility Modifier None Typical Low $281.84 Median $1,513.56 Typical High $9,772.37 | Facility | None | $281.84 | $1,513.56 | $9,772.37 |
AvMed Setting Professional Modifier None Typical Low $97.72 Median $229.09 Typical High $288.40 | Professional | None | $97.72 | $229.09 | $288.40 |
Cigna Setting Facility Modifier None Typical Low $363.08 Median $501.19 Typical High $1,659.59 | Facility | None | $363.08 | $501.19 | $1,659.59 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $173.78 Typical High $295.12 | Professional | None | $75.86 | $173.78 | $295.12 |
Florida Blue Setting Facility Modifier None Typical Low $363.08 Median $776.25 Typical High $4,570.88 | Facility | None | $363.08 | $776.25 | $4,570.88 |
Florida Blue Setting Professional Modifier None Typical Low $102.33 Median $229.09 Typical High $295.12 | Professional | None | $102.33 | $229.09 | $295.12 |
Molina Setting Professional Modifier None Typical Low $81.28 Median $229.09 Typical High $389.05 | Professional | None | $81.28 | $229.09 | $389.05 |
United Setting Facility Modifier None Typical Low $281.84 Median $660.69 Typical High $4,073.80 | Facility | None | $281.84 | $660.69 | $4,073.80 |
United Setting Professional Modifier None Typical Low $79.43 Median $173.78 Typical High $338.84 | Professional | None | $79.43 | $173.78 | $338.84 |
Wellpoint Setting Professional Modifier None Typical Low $74.13 Median $213.80 Typical High $213.80 | Professional | None | $74.13 | $213.80 | $213.80 |
8 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 $47.86 Median $100.00 Typical High $123.03 | Professional | 52 · Reduced service | $47.86 | $100.00 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $39.81 Typical High $48.98 | Professional | 53 · Discontinued | $19.05 | $39.81 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $70.79 Median $147.91 Typical High $181.97 | Professional | 54 · Surgery only | $70.79 | $147.91 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.45 Median $29.51 Typical High $37.15 | Professional | 55 · Aftercare only | $14.45 | $29.51 | $37.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $19.95 Typical High $24.55 | Professional | 56 · Pre-op care only | $9.55 | $19.95 | $24.55 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $251.19 Median $251.19 Typical High $251.19 | Professional | 59 · Distinct service | $251.19 | $251.19 | $251.19 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $275.42 Median $275.42 Typical High $275.42 | Professional | KX · Policy requirements met | $275.42 | $275.42 | $275.42 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $251.19 Median $251.19 Typical High $251.19 | Professional | Q6 · Substitute physician, paid per time | $251.19 | $251.19 | $251.19 |
Where Florida sits
The same service costs 5.3 times more in New York than in Maine. 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.
Physician feeFacility fee
NY $2,695ME $510
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.