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 $4.17 Median $4.17 Typical High $4.17 | Facility | None | $4.17 | $4.17 | $4.17 |
Aetna Setting Professional Modifier None Typical Low $4.17 Median $4.27 Typical High $6.17 | Professional | None | $4.17 | $4.27 | $6.17 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $2.04 Median $2.14 Typical High $2.82 | Professional | 52 · Reduced service | $2.04 | $2.14 | $2.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.83 Median $0.85 Typical High $1.12 | Professional | 53 · Discontinued | $0.83 | $0.85 | $1.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.62 Median $0.65 Typical High $0.85 | Professional | 55 · Aftercare only | $0.62 | $0.65 | $0.85 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.41 Median $0.43 Typical High $0.56 | Professional | 56 · Pre-op care only | $0.41 | $0.43 | $0.56 |
Ambetter Setting Professional Modifier None Typical Low $3.31 Median $4.47 Typical High $6.46 | Professional | None | $3.31 | $4.47 | $6.46 |
BCBS Tennessee Setting Professional Modifier None Typical Low $3.89 Median $3.89 Typical High $5.25 | Professional | None | $3.89 | $3.89 | $5.25 |
Cigna Setting Professional Modifier None Typical Low $3.02 Median $4.07 Typical High $6.03 | Professional | None | $3.02 | $4.07 | $6.03 |
Lucent Health Setting Professional Modifier None Typical Low $29.51 Median $29.51 Typical High $44.67 | Professional | None | $29.51 | $29.51 | $44.67 |
Optum Setting Professional Modifier None Typical Low $3.80 Median $4.79 Typical High $6.03 | Professional | None | $3.80 | $4.79 | $6.03 |
United Setting Professional Modifier None Typical Low $4.37 Median $5.37 Typical High $9.55 | Professional | None | $4.37 | $5.37 | $9.55 |
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 59 · Distinct service Typical Low $3.80 Median $4.47 Typical High $6.03 | Professional | 59 · Distinct service | $3.80 | $4.47 | $6.03 |
Ambetter Setting Professional Modifier HO · Master's level Typical Low $3.31 Median $3.31 Typical High $3.31 | Professional | HO · Master's level | $3.31 | $3.31 | $3.31 |
Ambetter Setting Professional Modifier TH · Pregnancy care Typical Low $4.57 Median $4.57 Typical High $4.57 | Professional | TH · Pregnancy care | $4.57 | $4.57 | $4.57 |
Ambetter Setting Professional Modifier XU · Unusual separate service Typical Low $5.75 Median $5.75 Typical High $6.76 | Professional | XU · Unusual separate service | $5.75 | $5.75 | $6.76 |
Where Tennessee sits
The same service costs 2.7 times more in North Dakota than in New Mexico. 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.
Tennessee· 43rd of 51
$4.37
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.