How much rates vary
Facilitymedian $200 · 10th to 90th $72 to $4,365Professionalmedian $126 · 10th to 90th $20 to $316
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 $676.08 Median $2,570.40 Typical High $6,918.31 | Facility | None | $676.08 | $2,570.40 | $6,918.31 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $144.54 Typical High $199.53 | Professional | None | $104.71 | $144.54 | $199.53 |
BCBS Texas Setting Facility Modifier None Typical Low $57.54 Median $107.15 Typical High $707.95 | Facility | None | $57.54 | $107.15 | $707.95 |
BCBS Texas Setting Professional Modifier None Typical Low $107.15 Median $173.78 Typical High $323.59 | Professional | None | $107.15 | $173.78 | $323.59 |
Christus Setting Facility Modifier None Typical Low $112.20 Median $112.20 Typical High $112.20 | Facility | None | $112.20 | $112.20 | $112.20 |
Cigna Setting Facility Modifier None Typical Low $93.33 Median $128.82 Typical High $2,290.87 | Facility | None | $93.33 | $128.82 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $162.18 Typical High $234.42 | Professional | None | $114.82 | $162.18 | $234.42 |
Lucent Health Setting Professional Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,412.54 | Professional | None | $1,230.27 | $1,230.27 | $1,412.54 |
Moda Health Setting Facility Modifier None Typical Low $128.82 Median $1,148.15 Typical High $4,786.30 | Facility | None | $128.82 | $1,148.15 | $4,786.30 |
Moda Health Setting Professional Modifier None Typical Low $104.71 Median $151.36 Typical High $199.53 | Professional | None | $104.71 | $151.36 | $199.53 |
Molina Setting Professional Modifier None Typical Low $17.38 Median $93.33 Typical High $162.18 | Professional | None | $17.38 | $93.33 | $162.18 |
Providence Setting Facility Modifier None Typical Low $100.00 Median $141.25 Typical High $2,290.87 | Facility | None | $100.00 | $141.25 | $2,290.87 |
Providence Setting Professional Modifier None Typical Low $114.82 Median $162.18 Typical High $234.42 | Professional | None | $114.82 | $162.18 | $234.42 |
United Setting Facility Modifier None Typical Low $1,258.93 Median $3,311.31 Typical High $6,760.83 | Facility | None | $1,258.93 | $3,311.31 | $6,760.83 |
United Setting Professional Modifier None Typical Low $97.72 Median $131.83 Typical High $204.17 | Professional | None | $97.72 | $131.83 | $204.17 |
Wellpoint Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
12 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 $52.48 Median $72.44 Typical High $100.00 | Professional | 52 · Reduced service | $52.48 | $72.44 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $28.84 Typical High $39.81 | Professional | 53 · Discontinued | $20.89 | $28.84 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $107.15 Typical High $147.91 | Professional | 54 · Surgery only | $77.62 | $107.15 | $147.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $21.88 Typical High $30.20 | Professional | 55 · Aftercare only | $15.49 | $21.88 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $14.45 Typical High $19.95 | Professional | 56 · Pre-op care only | $10.47 | $14.45 | $19.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $72.44 Median $100.00 Typical High $138.04 | Professional | 78 · Unplanned return to OR | $72.44 | $100.00 | $138.04 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $52.48 Median $74.13 Typical High $100.00 | Professional | 52 · Reduced service | $52.48 | $74.13 | $100.00 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $29.51 Typical High $39.81 | Professional | 53 · Discontinued | $20.89 | $29.51 | $39.81 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $112.20 Typical High $147.91 | Professional | 54 · Surgery only | $77.62 | $112.20 | $147.91 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $22.39 Typical High $30.20 | Professional | 55 · Aftercare only | $15.49 | $22.39 | $30.20 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $14.79 Typical High $19.95 | Professional | 56 · Pre-op care only | $10.47 | $14.79 | $19.95 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $72.44 Median $104.71 Typical High $138.04 | Professional | 78 · Unplanned return to OR | $72.44 | $104.71 | $138.04 |
Where Texas sits
The same service costs 3.6 times more in Wisconsin than in Texas. 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.
Texas· 51st of 51
$129
WI $468TX $129
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.