How much rates vary
Facilitymedian $7 · 10th to 90th $3 to $120Professionalmedian $3 · 10th to 90th $2 to $38
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 $3.24 Median $3.24 Typical High $3.55 | Facility | None | $3.24 | $3.24 | $3.55 |
Aetna Setting Professional Modifier None Typical Low $3.02 Median $3.31 Typical High $4.07 | Professional | None | $3.02 | $3.31 | $4.07 |
Ambetter Setting Professional Modifier None Typical Low $2.88 Median $3.55 Typical High $3.55 | Professional | None | $2.88 | $3.55 | $3.55 |
BCBS Texas Setting Facility Modifier None Typical Low $3.98 Median $5.75 Typical High $14.13 | Facility | None | $3.98 | $5.75 | $14.13 |
BCBS Texas Setting Professional Modifier None Typical Low $2.40 Median $2.69 Typical High $2.69 | Professional | None | $2.40 | $2.69 | $2.69 |
Christus Setting Facility Modifier None Typical Low $120.23 Median $120.23 Typical High $120.23 | Facility | None | $120.23 | $120.23 | $120.23 |
Cigna Setting Facility Modifier None Typical Low $3.02 Median $3.02 Typical High $3.16 | Facility | None | $3.02 | $3.02 | $3.16 |
Cigna Setting Professional Modifier None Typical Low $2.57 Median $2.57 Typical High $3.02 | Professional | None | $2.57 | $2.57 | $3.02 |
Lucent Health Setting Professional Modifier None Typical Low $25.12 Median $38.02 Typical High $38.02 | Professional | None | $25.12 | $38.02 | $38.02 |
Moda Health Setting Facility Modifier None Typical Low $1.38 Median $3.31 Typical High $5.13 | Facility | None | $1.38 | $3.31 | $5.13 |
Moda Health Setting Professional Modifier None Typical Low $3.02 Median $3.31 Typical High $4.37 | Professional | None | $3.02 | $3.31 | $4.37 |
Molina Setting Professional Modifier None Typical Low $2.82 Median $2.82 Typical High $81.28 | Professional | None | $2.82 | $2.82 | $81.28 |
Providence Setting Facility Modifier None Typical Low $2.14 Median $3.02 Typical High $5.13 | Facility | None | $2.14 | $3.02 | $5.13 |
Providence Setting Professional Modifier None Typical Low $2.57 Median $2.57 Typical High $3.02 | Professional | None | $2.57 | $2.57 | $3.02 |
United Setting Professional Modifier None Typical Low $1.62 Median $2.24 Typical High $3.02 | Professional | None | $1.62 | $2.24 | $3.02 |
Wellpoint Setting Professional Modifier None Typical Low $2.63 Median $2.63 Typical High $2.63 | Professional | None | $2.63 | $2.63 | $2.63 |
9 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 $1.51 Median $1.66 Typical High $2.04 | Professional | 52 · Reduced service | $1.51 | $1.66 | $2.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.60 Median $0.66 Typical High $0.85 | Professional | 53 · Discontinued | $0.60 | $0.66 | $0.85 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.45 Median $0.49 Typical High $0.65 | Professional | 55 · Aftercare only | $0.45 | $0.49 | $0.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.30 Median $0.33 Typical High $0.41 | Professional | 56 · Pre-op care only | $0.30 | $0.33 | $0.41 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $3.55 Median $3.55 Typical High $3.55 | Professional | KX · Policy requirements met | $3.55 | $3.55 | $3.55 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1.51 Median $1.66 Typical High $2.04 | Professional | 52 · Reduced service | $1.51 | $1.66 | $2.04 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.60 Median $0.66 Typical High $0.81 | Professional | 53 · Discontinued | $0.60 | $0.66 | $0.81 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.45 Median $0.49 Typical High $0.62 | Professional | 55 · Aftercare only | $0.45 | $0.49 | $0.62 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.30 Median $0.33 Typical High $0.41 | Professional | 56 · Pre-op care only | $0.30 | $0.33 | $0.41 |
Where Texas sits
The same service costs 2.3 times more in Kansas than in Connecticut. 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· 27th of 51
$3.24
KS $6.03CT $2.57
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.