How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $51.29 Median $60.26 Typical High $87.10 | Facility | None | $51.29 | $60.26 | $87.10 |
Aetna Setting Professional Modifier None Typical Low $57.54 Median $75.86 Typical High $112.20 | Professional | None | $57.54 | $75.86 | $112.20 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $25.12 Median $38.02 Typical High $44.67 | Professional | 52 · Reduced service | $25.12 | $38.02 | $44.67 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $11.22 Typical High $13.49 | Professional | 55 · Aftercare only | $7.59 | $11.22 | $13.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $7.59 Typical High $8.91 | Professional | 56 · Pre-op care only | $5.13 | $7.59 | $8.91 |
Ambetter Setting Professional Modifier None Typical Low $95.50 Median $112.20 Typical High $123.03 | Professional | None | $95.50 | $112.20 | $123.03 |
AvMed Setting Facility Modifier None Typical Low $64.57 Median $64.57 Typical High $64.57 | Facility | None | $64.57 | $64.57 | $64.57 |
AvMed Setting Professional Modifier None Typical Low $64.57 Median $85.11 Typical High $169.82 | Professional | None | $64.57 | $85.11 | $169.82 |
Cigna Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $89.13 | Facility | None | $89.13 | $89.13 | $89.13 |
Cigna Setting Professional Modifier None Typical Low $52.48 Median $75.86 Typical High $117.49 | Professional | None | $52.48 | $75.86 | $117.49 |
Florida Blue Setting Professional Modifier None Typical Low $42.66 Median $91.20 Typical High $120.23 | Professional | None | $42.66 | $91.20 | $120.23 |
Molina Setting Professional Modifier None Typical Low $58.88 Median $102.33 Typical High $131.83 | Professional | None | $58.88 | $102.33 | $131.83 |
United Setting Professional Modifier None Typical Low $48.98 Median $74.13 Typical High $120.23 | Professional | None | $48.98 | $74.13 | $120.23 |
Wellpoint Setting Professional Modifier None Typical Low $53.70 Median $70.79 Typical High $70.79 | Professional | None | $53.70 | $70.79 | $70.79 |
4 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 |
|---|---|---|---|---|---|
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $95.50 Median $112.20 Typical High $117.49 | Professional | 25 · Same-day visit | $95.50 | $112.20 | $117.49 |
Ambetter Setting Professional Modifier EP · Child screening program Typical Low $95.50 Median $95.50 Typical High $107.15 | Professional | EP · Child screening program | $95.50 | $95.50 | $107.15 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | GC · Resident with teaching physician | $112.20 | $112.20 | $112.20 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $120.23 Median $120.23 Typical High $120.23 | Professional | SA · Nurse practitioner | $120.23 | $120.23 | $120.23 |
Where Florida sits
The same service costs 2.9 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.
Florida· 49th of 51
$75.86
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.