How much rates vary
Facilitymedian $6 · 10th to 90th $4 to $14Professionalmedian $4 · 10th to 90th $2 to $87
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 $3.47 Median $3.47 Typical High $3.80 | Facility | None | $3.47 | $3.47 | $3.80 |
Aetna Setting Professional Modifier None Typical Low $3.31 Median $3.55 Typical High $4.57 | Professional | None | $3.31 | $3.55 | $4.57 |
BCBS Texas Setting Facility Modifier None Typical Low $4.47 Median $6.92 Typical High $15.14 | Facility | None | $4.47 | $6.92 | $15.14 |
BCBS Texas Setting Professional Modifier None Typical Low $4.47 Median $4.47 Typical High $4.47 | Professional | None | $4.47 | $4.47 | $4.47 |
Cigna Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | None | $2.24 | $2.24 | $2.24 |
Lucent Health Setting Professional Modifier None Typical Low $45.71 Median $45.71 Typical High $87.10 | Professional | None | $45.71 | $45.71 | $87.10 |
Moda Health Setting Facility Modifier None Typical Low $3.47 Median $5.50 Typical High $12.88 | Facility | None | $3.47 | $5.50 | $12.88 |
Moda Health Setting Professional Modifier None Typical Low $3.47 Median $3.55 Typical High $4.57 | Professional | None | $3.47 | $3.55 | $4.57 |
Oscar Health Setting Professional Modifier None Typical Low $20.42 Median $20.42 Typical High $20.42 | Professional | None | $20.42 | $20.42 | $20.42 |
Providence Setting Facility Modifier None Typical Low $3.55 Median $5.50 Typical High $12.88 | Facility | None | $3.55 | $5.50 | $12.88 |
Providence Setting Professional Modifier None Typical Low $2.24 Median $2.24 Typical High $2.24 | Professional | None | $2.24 | $2.24 | $2.24 |
United Setting Professional Modifier None Typical Low $1.91 Median $2.45 Typical High $3.72 | Professional | None | $1.91 | $2.45 | $3.72 |
Wellpoint Setting Professional Modifier None Typical Low $5.50 Median $5.50 Typical High $5.50 | Professional | None | $5.50 | $5.50 | $5.50 |
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 $1.62 Median $1.78 Typical High $2.29 | Professional | 52 · Reduced service | $1.62 | $1.78 | $2.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.65 Median $0.71 Typical High $0.91 | Professional | 53 · Discontinued | $0.65 | $0.71 | $0.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.45 Median $2.63 Typical High $3.47 | Professional | 54 · Surgery only | $2.45 | $2.63 | $3.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.49 Median $0.52 Typical High $0.69 | Professional | 55 · Aftercare only | $0.49 | $0.52 | $0.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.33 Median $0.35 Typical High $0.46 | Professional | 56 · Pre-op care only | $0.33 | $0.35 | $0.46 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1.66 Median $1.78 Typical High $2.19 | Professional | 52 · Reduced service | $1.66 | $1.78 | $2.19 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.66 Median $0.71 Typical High $0.87 | Professional | 53 · Discontinued | $0.66 | $0.71 | $0.87 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $2.45 Median $2.63 Typical High $3.24 | Professional | 54 · Surgery only | $2.45 | $2.63 | $3.24 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.49 Median $0.52 Typical High $0.66 | Professional | 55 · Aftercare only | $0.49 | $0.52 | $0.66 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.33 Median $0.35 Typical High $0.44 | Professional | 56 · Pre-op care only | $0.33 | $0.35 | $0.44 |
Where Texas sits
The same service costs 3.8 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
$3.55
RI $8.32NY $2.19
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.