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 $66.07 Median $77.62 Typical High $102.33 | Facility | None | $66.07 | $77.62 | $102.33 |
Aetna Setting Professional Modifier None Typical Low $72.44 Median $95.50 Typical High $134.90 | Professional | None | $72.44 | $95.50 | $134.90 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $33.11 Median $44.67 Typical High $56.23 | Professional | 52 · Reduced service | $33.11 | $44.67 | $56.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $13.49 Typical High $16.60 | Professional | 55 · Aftercare only | $9.77 | $13.49 | $16.60 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $8.91 Typical High $11.22 | Professional | 56 · Pre-op care only | $6.61 | $8.91 | $11.22 |
Ambetter Setting Professional Modifier None Typical Low $107.15 Median $120.23 Typical High $144.54 | Professional | None | $107.15 | $120.23 | $144.54 |
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 $89.13 Typical High $169.82 | Professional | None | $64.57 | $89.13 | $169.82 |
Cigna Setting Facility Modifier None Typical Low $114.82 Median $114.82 Typical High $114.82 | Facility | None | $114.82 | $114.82 | $114.82 |
Cigna Setting Professional Modifier None Typical Low $66.07 Median $89.13 Typical High $144.54 | Professional | None | $66.07 | $89.13 | $144.54 |
Florida Blue Setting Professional Modifier None Typical Low $50.12 Median $107.15 Typical High $144.54 | Professional | None | $50.12 | $107.15 | $144.54 |
Molina Setting Professional Modifier None Typical Low $70.79 Median $107.15 Typical High $173.78 | Professional | None | $70.79 | $107.15 | $173.78 |
United Setting Professional Modifier None Typical Low $60.26 Median $93.33 Typical High $144.54 | Professional | None | $60.26 | $93.33 | $144.54 |
Wellpoint Setting Professional Modifier None Typical Low $64.57 Median $104.71 Typical High $104.71 | Professional | None | $64.57 | $104.71 | $104.71 |
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 |
|---|---|---|---|---|---|
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $112.20 Median $134.90 Typical High $144.54 | Professional | 25 · Same-day visit | $112.20 | $134.90 | $144.54 |
Ambetter Setting Professional Modifier EP · Child screening program Typical Low $131.83 Median $131.83 Typical High $131.83 | Professional | EP · Child screening program | $131.83 | $131.83 | $131.83 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $114.82 Median $123.03 Typical High $144.54 | Professional | GC · Resident with teaching physician | $114.82 | $123.03 | $144.54 |
Ambetter Setting Professional Modifier GY · Excluded by law Typical Low $134.90 Median $134.90 Typical High $162.18 | Professional | GY · Excluded by law | $134.90 | $134.90 | $162.18 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $114.82 Median $114.82 Typical High $114.82 | Professional | KX · Policy requirements met | $114.82 | $114.82 | $114.82 |
Wellpoint Setting Professional Modifier EP · Child screening program Typical Low $66.07 Median $66.07 Typical High $70.79 | Professional | EP · Child screening program | $66.07 | $66.07 | $70.79 |
Where Florida 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.
Florida· 49th of 51
$95.50
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.