How much rates vary
Facilitymedian $17 · 10th to 90th $10 to $33Professionalmedian $11 · 10th to 90th $7 to $224
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 $10.47 Median $10.47 Typical High $11.48 | Facility | None | $10.47 | $10.47 | $11.48 |
Aetna Setting Professional Modifier None Typical Low $10.00 Median $10.72 Typical High $12.02 | Professional | None | $10.00 | $10.72 | $12.02 |
BCBS Texas Setting Professional Modifier None Typical Low $13.49 Median $13.49 Typical High $13.49 | Professional | None | $13.49 | $13.49 | $13.49 |
Cigna Setting Professional Modifier None Typical Low $6.76 Median $6.76 Typical High $6.76 | Professional | None | $6.76 | $6.76 | $6.76 |
Lucent Health Setting Professional Modifier None Typical Low $123.03 Median $123.03 Typical High $223.87 | Professional | None | $123.03 | $123.03 | $223.87 |
Moda Health Setting Facility Modifier None Typical Low $10.47 Median $16.60 Typical High $39.81 | Facility | None | $10.47 | $16.60 | $39.81 |
Moda Health Setting Professional Modifier None Typical Low $10.47 Median $10.72 Typical High $13.80 | Professional | None | $10.47 | $10.72 | $13.80 |
Oscar Health Setting Professional Modifier None Typical Low $60.26 Median $60.26 Typical High $60.26 | Professional | None | $60.26 | $60.26 | $60.26 |
Providence Setting Facility Modifier None Typical Low $10.72 Median $16.60 Typical High $33.11 | Facility | None | $10.72 | $16.60 | $33.11 |
Providence Setting Professional Modifier None Typical Low $6.76 Median $6.76 Typical High $6.76 | Professional | None | $6.76 | $6.76 | $6.76 |
United Setting Professional Modifier None Typical Low $5.75 Median $7.41 Typical High $11.22 | Professional | None | $5.75 | $7.41 | $11.22 |
Wellpoint Setting Professional Modifier None Typical Low $16.60 Median $16.60 Typical High $16.60 | Professional | None | $16.60 | $16.60 | $16.60 |
10 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 $4.90 Median $5.37 Typical High $6.92 | Professional | 52 · Reduced service | $4.90 | $5.37 | $6.92 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.95 Median $2.14 Typical High $2.75 | Professional | 53 · Discontinued | $1.95 | $2.14 | $2.75 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $7.41 Median $7.94 Typical High $10.23 | Professional | 54 · Surgery only | $7.41 | $7.94 | $10.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.48 Median $1.58 Typical High $2.04 | Professional | 55 · Aftercare only | $1.48 | $1.58 | $2.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.98 Median $1.07 Typical High $1.38 | Professional | 56 · Pre-op care only | $0.98 | $1.07 | $1.38 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $4.90 Median $5.37 Typical High $6.76 | Professional | 52 · Reduced service | $4.90 | $5.37 | $6.76 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $2.00 Median $2.14 Typical High $2.69 | Professional | 53 · Discontinued | $2.00 | $2.14 | $2.69 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $7.41 Median $7.94 Typical High $10.00 | Professional | 54 · Surgery only | $7.41 | $7.94 | $10.00 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $1.48 Median $1.58 Typical High $2.00 | Professional | 55 · Aftercare only | $1.48 | $1.58 | $2.00 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $1.00 Median $1.07 Typical High $1.35 | Professional | 56 · Pre-op care only | $1.00 | $1.07 | $1.35 |
Where Texas sits
The same service costs 3.2 times more in Rhode Island than in New York. 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
$10.72
RI $21.38NY $6.61
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.