How much rates vary
Facilitymedian $65 · 10th to 90th $58 to $78Professionalmedian $68 · 10th to 90th $56 to $129
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 $57.54 Median $61.66 Typical High $75.86 | Facility | None | $57.54 | $61.66 | $75.86 |
Aetna Setting Professional Modifier None Typical Low $57.54 Median $66.07 Typical High $114.82 | Professional | None | $57.54 | $66.07 | $114.82 |
Ambetter Setting Professional Modifier None Typical Low $58.88 Median $74.13 Typical High $141.25 | Professional | None | $58.88 | $74.13 | $141.25 |
AvMed Setting Facility Modifier None Typical Low $58.88 Median $74.13 Typical High $77.62 | Facility | None | $58.88 | $74.13 | $77.62 |
AvMed Setting Professional Modifier None Typical Low $58.88 Median $72.44 Typical High $79.43 | Professional | None | $58.88 | $72.44 | $79.43 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $100.00 Typical High $100.00 | Facility | None | $100.00 | $100.00 | $100.00 |
Cigna Setting Professional Modifier None Typical Low $56.23 Median $67.61 Typical High $138.04 | Professional | None | $56.23 | $67.61 | $138.04 |
Florida Blue Setting Professional Modifier None Typical Low $50.12 Median $54.95 Typical High $72.44 | Professional | None | $50.12 | $54.95 | $72.44 |
Molina Setting Professional Modifier None Typical Low $53.70 Median $83.18 Typical High $141.25 | Professional | None | $53.70 | $83.18 | $141.25 |
United Setting Professional Modifier None Typical Low $51.29 Median $74.13 Typical High $144.54 | Professional | None | $51.29 | $74.13 | $144.54 |
Wellpoint Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $70.79 | Professional | None | $54.95 | $54.95 | $70.79 |
14 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 $28.84 Median $30.20 Typical High $34.67 | Facility | 52 · Reduced service | $28.84 | $30.20 | $34.67 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $8.71 Median $8.91 Typical High $10.47 | Facility | 55 · Aftercare only | $8.71 | $8.91 | $10.47 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $5.75 Median $6.03 Typical High $6.92 | Facility | 56 · Pre-op care only | $5.75 | $6.03 | $6.92 |
Aetna Setting Facility Modifier AF · Specialist physician Typical Low $60.26 Median $66.07 Typical High $77.62 | Facility | AF · Specialist physician | $60.26 | $66.07 | $77.62 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $28.84 Median $30.20 Typical High $35.48 | Professional | 52 · Reduced service | $28.84 | $30.20 | $35.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.71 Median $8.91 Typical High $10.72 | Professional | 55 · Aftercare only | $8.71 | $8.91 | $10.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $6.03 Typical High $7.08 | Professional | 56 · Pre-op care only | $5.75 | $6.03 | $7.08 |
Ambetter Setting Professional Modifier 24 · Unrelated visit after surgery Typical Low $75.86 Median $79.43 Typical High $125.89 | Professional | 24 · Unrelated visit after surgery | $75.86 | $79.43 | $125.89 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $63.10 Median $72.44 Typical High $120.23 | Professional | 25 · Same-day visit | $63.10 | $72.44 | $120.23 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $72.44 Median $89.13 Typical High $125.89 | Professional | 57 · Decision for surgery | $72.44 | $89.13 | $125.89 |
Ambetter Setting Professional Modifier FS · Shared visit Typical Low $61.66 Median $72.44 Typical High $107.15 | Professional | FS · Shared visit | $61.66 | $72.44 | $107.15 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $72.44 Median $74.13 Typical High $141.25 | Professional | GC · Resident with teaching physician | $72.44 | $74.13 | $141.25 |
Ambetter Setting Professional Modifier GW · Unrelated to hospice condition Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | GW · Unrelated to hospice condition | $75.86 | $75.86 | $75.86 |
Ambetter Setting Professional Modifier Q5 · Substitute physician, reciprocal Typical Low $72.44 Median $72.44 Typical High $72.44 | Professional | Q5 · Substitute physician, reciprocal | $72.44 | $72.44 | $72.44 |
Where Florida sits
The same service costs 2.4 times more in Alaska than in Alabama. 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· 49th of 51
$67.61
AK $155AL $64.57
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.