How much rates vary
Facilitymedian $7 · 10th to 90th $4 to $15Professionalmedian $4 · 10th to 90th $2 to $72
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 $3.72 Median $3.72 Typical High $4.07 | Facility | None | $3.72 | $3.72 | $4.07 |
Aetna Setting Professional Modifier None Typical Low $3.47 Median $3.72 Typical High $4.79 | Professional | None | $3.47 | $3.72 | $4.79 |
BCBS Texas Setting Facility Modifier None Typical Low $4.57 Median $7.41 Typical High $15.85 | Facility | None | $4.57 | $7.41 | $15.85 |
BCBS Texas Setting Professional Modifier None Typical Low $4.68 Median $4.68 Typical High $4.68 | Professional | None | $4.68 | $4.68 | $4.68 |
Cigna Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
Lucent Health Setting Professional Modifier None Typical Low $43.65 Median $43.65 Typical High $72.44 | Professional | None | $43.65 | $43.65 | $72.44 |
Moda Health Setting Facility Modifier None Typical Low $3.72 Median $5.75 Typical High $10.47 | Facility | None | $3.72 | $5.75 | $10.47 |
Moda Health Setting Professional Modifier None Typical Low $3.63 Median $3.72 Typical High $4.90 | Professional | None | $3.63 | $3.72 | $4.90 |
Oscar Health Setting Professional Modifier None Typical Low $21.38 Median $21.38 Typical High $21.38 | Professional | None | $21.38 | $21.38 | $21.38 |
Providence Setting Facility Modifier None Typical Low $3.72 Median $5.75 Typical High $10.47 | Facility | None | $3.72 | $5.75 | $10.47 |
Providence Setting Professional Modifier None Typical Low $2.34 Median $2.34 Typical High $2.34 | Professional | None | $2.34 | $2.34 | $2.34 |
United Setting Professional Modifier None Typical Low $2.04 Median $2.57 Typical High $3.89 | Professional | None | $2.04 | $2.57 | $3.89 |
Wellpoint Setting Professional Modifier None Typical Low $5.75 Median $5.75 Typical High $5.75 | Professional | None | $5.75 | $5.75 | $5.75 |
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 $1.74 Median $1.86 Typical High $2.40 | Professional | 52 · Reduced service | $1.74 | $1.86 | $2.40 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.69 Median $0.76 Typical High $0.95 | Professional | 53 · Discontinued | $0.69 | $0.76 | $0.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.57 Median $2.82 Typical High $3.63 | Professional | 54 · Surgery only | $2.57 | $2.82 | $3.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.52 Median $0.56 Typical High $0.72 | Professional | 55 · Aftercare only | $0.52 | $0.56 | $0.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.34 Median $0.37 Typical High $0.48 | Professional | 56 · Pre-op care only | $0.34 | $0.37 | $0.48 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1.74 Median $1.86 Typical High $2.29 | Professional | 52 · Reduced service | $1.74 | $1.86 | $2.29 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.69 Median $0.76 Typical High $0.91 | Professional | 53 · Discontinued | $0.69 | $0.76 | $0.91 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $2.57 Median $2.82 Typical High $3.47 | Professional | 54 · Surgery only | $2.57 | $2.82 | $3.47 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.52 Median $0.56 Typical High $0.69 | Professional | 55 · Aftercare only | $0.52 | $0.56 | $0.69 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.34 Median $0.37 Typical High $0.46 | Professional | 56 · Pre-op care only | $0.34 | $0.37 | $0.46 |
Where Texas sits
The same service costs 3.0 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· 26th of 51
$3.72
RI $6.76NY $2.29
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.