How much rates vary
Facilitymedian $10 · 10th to 90th $6 to $22Professionalmedian $5 · 10th to 90th $3 to $112
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 $5.25 Median $5.25 Typical High $5.75 | Facility | None | $5.25 | $5.25 | $5.75 |
Aetna Setting Professional Modifier None Typical Low $5.13 Median $5.25 Typical High $6.92 | Professional | None | $5.13 | $5.25 | $6.92 |
Ambetter Setting Professional Modifier None Typical Low $6.17 Median $6.17 Typical High $6.17 | Professional | None | $6.17 | $6.17 | $6.17 |
BCBS Texas Setting Facility Modifier None Typical Low $6.46 Median $10.47 Typical High $22.91 | Facility | None | $6.46 | $10.47 | $22.91 |
BCBS Texas Setting Professional Modifier None Typical Low $6.61 Median $6.61 Typical High $6.61 | Professional | None | $6.61 | $6.61 | $6.61 |
Cigna Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | None | $3.39 | $3.39 | $3.39 |
Lucent Health Setting Professional Modifier None Typical Low $61.66 Median $61.66 Typical High $112.20 | Professional | None | $61.66 | $61.66 | $112.20 |
Moda Health Setting Facility Modifier None Typical Low $5.25 Median $8.32 Typical High $16.60 | Facility | None | $5.25 | $8.32 | $16.60 |
Moda Health Setting Professional Modifier None Typical Low $5.25 Median $5.25 Typical High $6.92 | Professional | None | $5.25 | $5.25 | $6.92 |
Oscar Health Setting Professional Modifier None Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | None | $30.20 | $30.20 | $30.20 |
Providence Setting Facility Modifier None Typical Low $5.37 Median $8.32 Typical High $16.60 | Facility | None | $5.37 | $8.32 | $16.60 |
Providence Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | None | $3.39 | $3.39 | $3.39 |
United Setting Professional Modifier None Typical Low $2.88 Median $3.72 Typical High $5.62 | Professional | None | $2.88 | $3.72 | $5.62 |
Wellpoint Setting Professional Modifier None Typical Low $8.32 Median $8.32 Typical High $8.32 | Professional | None | $8.32 | $8.32 | $8.32 |
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 $2.45 Median $2.63 Typical High $3.47 | Professional | 52 · Reduced service | $2.45 | $2.63 | $3.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.98 Median $1.07 Typical High $1.38 | Professional | 53 · Discontinued | $0.98 | $1.07 | $1.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.63 Median $3.98 Typical High $5.13 | Professional | 54 · Surgery only | $3.63 | $3.98 | $5.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.72 Median $0.79 Typical High $1.02 | Professional | 55 · Aftercare only | $0.72 | $0.79 | $1.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.49 Median $0.52 Typical High $0.69 | Professional | 56 · Pre-op care only | $0.49 | $0.52 | $0.69 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $2.45 Median $2.63 Typical High $3.39 | Professional | 52 · Reduced service | $2.45 | $2.63 | $3.39 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $1.00 Median $1.07 Typical High $1.35 | Professional | 53 · Discontinued | $1.00 | $1.07 | $1.35 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $3.72 Median $3.98 Typical High $5.01 | Professional | 54 · Surgery only | $3.72 | $3.98 | $5.01 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.74 Median $0.79 Typical High $1.00 | Professional | 55 · Aftercare only | $0.74 | $0.79 | $1.00 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.49 Median $0.52 Typical High $0.68 | Professional | 56 · Pre-op care only | $0.49 | $0.52 | $0.68 |
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
$5.37
RI $10.72NY $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.