How much rates vary
Facilitymedian $10 · 10th to 90th $6 to $23Professionalmedian $5 · 10th to 90th $3 to $145
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 $5.50 Median $5.50 Typical High $6.03 | Facility | None | $5.50 | $5.50 | $6.03 |
Aetna Setting Professional Modifier None Typical Low $5.37 Median $5.50 Typical High $7.24 | Professional | None | $5.37 | $5.50 | $7.24 |
Ambetter Setting Professional Modifier None Typical Low $4.27 Median $4.27 Typical High $14.79 | Professional | None | $4.27 | $4.27 | $14.79 |
BCBS Texas Setting Facility Modifier None Typical Low $6.76 Median $10.96 Typical High $23.44 | Facility | None | $6.76 | $10.96 | $23.44 |
BCBS Texas Setting Professional Modifier None Typical Low $6.92 Median $6.92 Typical High $6.92 | Professional | None | $6.92 | $6.92 | $6.92 |
Cigna Setting Professional Modifier None Typical Low $3.47 Median $3.47 Typical High $3.47 | Professional | None | $3.47 | $3.47 | $3.47 |
Lucent Health Setting Professional Modifier None Typical Low $74.13 Median $74.13 Typical High $144.54 | Professional | None | $74.13 | $74.13 | $144.54 |
Moda Health Setting Facility Modifier None Typical Low $5.50 Median $8.51 Typical High $21.38 | Facility | None | $5.50 | $8.51 | $21.38 |
Moda Health Setting Professional Modifier None Typical Low $5.50 Median $5.50 Typical High $7.41 | Professional | None | $5.50 | $5.50 | $7.41 |
Oscar Health Setting Professional Modifier None Typical Low $31.62 Median $31.62 Typical High $31.62 | Professional | None | $31.62 | $31.62 | $31.62 |
Providence Setting Facility Modifier None Typical Low $5.50 Median $8.51 Typical High $21.38 | Facility | None | $5.50 | $8.51 | $21.38 |
Providence Setting Professional Modifier None Typical Low $3.47 Median $3.47 Typical High $3.47 | Professional | None | $3.47 | $3.47 | $3.47 |
United Setting Professional Modifier None Typical Low $2.95 Median $3.80 Typical High $5.75 | Professional | None | $2.95 | $3.80 | $5.75 |
Wellpoint Setting Professional Modifier None Typical Low $8.51 Median $8.51 Typical High $8.51 | Professional | None | $8.51 | $8.51 | $8.51 |
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 $2.51 Median $2.75 Typical High $3.55 | Professional | 52 · Reduced service | $2.51 | $2.75 | $3.55 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.02 Median $1.12 Typical High $1.45 | Professional | 53 · Discontinued | $1.02 | $1.12 | $1.45 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3.80 Median $4.17 Typical High $5.37 | Professional | 54 · Surgery only | $3.80 | $4.17 | $5.37 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.76 Median $0.83 Typical High $1.07 | Professional | 55 · Aftercare only | $0.76 | $0.83 | $1.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.51 Median $0.55 Typical High $0.72 | Professional | 56 · Pre-op care only | $0.51 | $0.55 | $0.72 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $2.57 Median $2.75 Typical High $3.39 | Professional | 52 · Reduced service | $2.57 | $2.75 | $3.39 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $1.02 Median $1.12 Typical High $1.35 | Professional | 53 · Discontinued | $1.02 | $1.12 | $1.35 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $3.89 Median $4.17 Typical High $5.13 | Professional | 54 · Surgery only | $3.89 | $4.17 | $5.13 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.78 Median $0.83 Typical High $1.02 | Professional | 55 · Aftercare only | $0.78 | $0.83 | $1.02 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.51 Median $0.55 Typical High $0.69 | Professional | 56 · Pre-op care only | $0.51 | $0.55 | $0.69 |
Where Texas sits
The same service costs 4.1 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· 28th of 51
$5.50
RI $13.80NY $3.39
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.