How much rates vary
Facilitymedian $10 · 10th to 90th $4 to $98Professionalmedian $4 · 10th to 90th $3 to $50
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 $4.27 Median $4.27 Typical High $4.68 | Facility | None | $4.27 | $4.27 | $4.68 |
Aetna Setting Professional Modifier None Typical Low $3.98 Median $4.27 Typical High $5.37 | Professional | None | $3.98 | $4.27 | $5.37 |
Ambetter Setting Professional Modifier None Typical Low $3.98 Median $4.68 Typical High $4.68 | Professional | None | $3.98 | $4.68 | $4.68 |
BCBS Texas Setting Facility Modifier None Typical Low $5.25 Median $7.76 Typical High $18.62 | Facility | None | $5.25 | $7.76 | $18.62 |
BCBS Texas Setting Professional Modifier None Typical Low $3.09 Median $3.47 Typical High $3.47 | Professional | None | $3.09 | $3.47 | $3.47 |
Christus Setting Facility Modifier None Typical Low $97.72 Median $97.72 Typical High $97.72 | Facility | None | $97.72 | $97.72 | $97.72 |
Cigna Setting Facility Modifier None Typical Low $3.89 Median $3.89 Typical High $4.17 | Facility | None | $3.89 | $3.89 | $4.17 |
Cigna Setting Professional Modifier None Typical Low $3.31 Median $3.31 Typical High $3.89 | Professional | None | $3.31 | $3.31 | $3.89 |
Lucent Health Setting Professional Modifier None Typical Low $33.11 Median $50.12 Typical High $50.12 | Professional | None | $33.11 | $50.12 | $50.12 |
Moda Health Setting Facility Modifier None Typical Low $4.07 Median $6.31 Typical High $6.61 | Facility | None | $4.07 | $6.31 | $6.61 |
Moda Health Setting Professional Modifier None Typical Low $3.98 Median $4.27 Typical High $5.62 | Professional | None | $3.98 | $4.27 | $5.62 |
Molina Setting Professional Modifier None Typical Low $3.80 Median $3.80 Typical High $81.28 | Professional | None | $3.80 | $3.80 | $81.28 |
Providence Setting Facility Modifier None Typical Low $3.89 Median $4.07 Typical High $6.61 | Facility | None | $3.89 | $4.07 | $6.61 |
Providence Setting Professional Modifier None Typical Low $3.31 Median $3.31 Typical High $3.89 | Professional | None | $3.31 | $3.31 | $3.89 |
United Setting Professional Modifier None Typical Low $2.14 Median $2.95 Typical High $4.27 | Professional | None | $2.14 | $2.95 | $4.27 |
Wellpoint Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | None | $3.39 | $3.39 | $3.39 |
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 $2.00 Median $2.14 Typical High $2.63 | Professional | 52 · Reduced service | $2.00 | $2.14 | $2.63 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.79 Median $0.85 Typical High $1.07 | Professional | 53 · Discontinued | $0.79 | $0.85 | $1.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.59 Median $0.65 Typical High $0.79 | Professional | 55 · Aftercare only | $0.59 | $0.65 | $0.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.40 Median $0.43 Typical High $0.52 | Professional | 56 · Pre-op care only | $0.40 | $0.43 | $0.52 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $4.68 Median $4.68 Typical High $4.68 | Professional | KX · Policy requirements met | $4.68 | $4.68 | $4.68 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $2.00 Median $2.14 Typical High $2.63 | Professional | 52 · Reduced service | $2.00 | $2.14 | $2.63 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.79 Median $0.85 Typical High $1.07 | Professional | 53 · Discontinued | $0.79 | $0.85 | $1.07 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.59 Median $0.65 Typical High $0.79 | Professional | 55 · Aftercare only | $0.59 | $0.65 | $0.79 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.40 Median $0.43 Typical High $0.52 | Professional | 56 · Pre-op care only | $0.40 | $0.43 | $0.52 |
Where Texas sits
The same service costs 2.1 times more in Montana than in New Jersey. 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· 26th of 51
$4.27
MT $6.92NJ $3.31
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.