How much rates vary
Facilitymedian $1 · 10th to 90th $1 to $3Professionalmedian $1 · 10th to 90th $1 to $10
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 $0.85 Median $1.62 Typical High $2.19 | Facility | None | $0.85 | $1.62 | $2.19 |
Aetna Setting Professional Modifier None Typical Low $0.85 Median $0.85 Typical High $0.89 | Professional | None | $0.85 | $0.85 | $0.89 |
Cigna Setting Facility Modifier None Typical Low $0.85 Median $2.04 Typical High $2.88 | Facility | None | $0.85 | $2.04 | $2.88 |
Cigna Setting Professional Modifier None Typical Low $0.85 Median $0.85 Typical High $0.85 | Professional | None | $0.85 | $0.85 | $0.85 |
Lucent Health Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $9.77 | Professional | None | $9.77 | $9.77 | $9.77 |
Moda Health Setting Facility Modifier None Typical Low $1.00 Median $1.32 Typical High $2.45 | Facility | None | $1.00 | $1.32 | $2.45 |
Moda Health Setting Professional Modifier None Typical Low $1.00 Median $1.00 Typical High $1.05 | Professional | None | $1.00 | $1.00 | $1.05 |
Molina Setting Professional Modifier None Typical Low $0.62 Median $0.87 Typical High $1.02 | Professional | None | $0.62 | $0.87 | $1.02 |
Providence Setting Facility Modifier None Typical Low $0.85 Median $1.23 Typical High $7.41 | Facility | None | $0.85 | $1.23 | $7.41 |
Providence Setting Professional Modifier None Typical Low $0.85 Median $0.85 Typical High $0.85 | Professional | None | $0.85 | $0.85 | $0.85 |
United Setting Professional Modifier None Typical Low $1.00 Median $1.00 Typical High $1.05 | Professional | None | $1.00 | $1.00 | $1.05 |
Wellpoint Setting Professional Modifier None Typical Low $0.62 Median $0.62 Typical High $0.62 | Professional | None | $0.62 | $0.62 | $0.62 |
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 Facility Modifier 52 · Reduced service Typical Low $0.43 Median $0.81 Typical High $1.10 | Facility | 52 · Reduced service | $0.43 | $0.81 | $1.10 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.17 Median $0.32 Typical High $0.44 | Facility | 53 · Discontinued | $0.17 | $0.32 | $0.44 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.13 Median $0.23 Typical High $0.33 | Facility | 55 · Aftercare only | $0.13 | $0.23 | $0.33 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.09 Median $0.15 Typical High $0.22 | Facility | 56 · Pre-op care only | $0.09 | $0.15 | $0.22 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.43 Median $0.43 Typical High $0.45 | Professional | 52 · Reduced service | $0.43 | $0.43 | $0.45 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.17 Median $0.17 Typical High $0.18 | Professional | 53 · Discontinued | $0.17 | $0.17 | $0.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.13 Median $0.13 Typical High $0.13 | Professional | 55 · Aftercare only | $0.13 | $0.13 | $0.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.09 Median $0.09 Typical High $0.09 | Professional | 56 · Pre-op care only | $0.09 | $0.09 | $0.09 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $0.51 Median $0.51 Typical High $0.52 | Professional | 52 · Reduced service | $0.51 | $0.51 | $0.52 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.20 Median $0.20 Typical High $0.21 | Professional | 53 · Discontinued | $0.20 | $0.20 | $0.21 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.15 Median $0.15 Typical High $0.16 | Professional | 55 · Aftercare only | $0.15 | $0.15 | $0.16 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.10 Median $0.10 Typical High $0.10 | Professional | 56 · Pre-op care only | $0.10 | $0.10 | $0.10 |
Where Texas sits
The same service costs 3.7 times more in North Carolina than in Virginia. 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· 38th of 51
$0.85
NC $3.16VA $0.85
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.