How much rates vary
Facilitymedian $26 · 10th to 90th $19 to $66Professionalmedian $17 · 10th to 90th $10 to $178
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 $15.14 Median $15.14 Typical High $16.60 | Facility | None | $15.14 | $15.14 | $16.60 |
Aetna Setting Professional Modifier None Typical Low $14.45 Median $15.14 Typical High $19.95 | Professional | None | $14.45 | $15.14 | $19.95 |
Ambetter Setting Professional Modifier None Typical Low $12.30 Median $12.30 Typical High $14.45 | Professional | None | $12.30 | $12.30 | $14.45 |
BCBS Texas Setting Facility Modifier None Typical Low $18.62 Median $28.18 Typical High $66.07 | Facility | None | $18.62 | $28.18 | $66.07 |
BCBS Texas Setting Professional Modifier None Typical Low $19.05 Median $19.05 Typical High $19.05 | Professional | None | $19.05 | $19.05 | $19.05 |
Cigna Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $9.77 | Professional | None | $9.77 | $9.77 | $9.77 |
Lucent Health Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $281.84 | Professional | None | $177.83 | $177.83 | $281.84 |
Moda Health Setting Facility Modifier None Typical Low $15.14 Median $23.99 Typical High $41.69 | Facility | None | $15.14 | $23.99 | $41.69 |
Moda Health Setting Professional Modifier None Typical Low $14.79 Median $15.14 Typical High $20.42 | Professional | None | $14.79 | $15.14 | $20.42 |
Oscar Health Setting Professional Modifier None Typical Low $87.10 Median $87.10 Typical High $87.10 | Professional | None | $87.10 | $87.10 | $87.10 |
Providence Setting Facility Modifier None Typical Low $15.14 Median $23.99 Typical High $41.69 | Facility | None | $15.14 | $23.99 | $41.69 |
Providence Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $9.77 | Professional | None | $9.77 | $9.77 | $9.77 |
United Setting Professional Modifier None Typical Low $8.32 Median $10.47 Typical High $15.85 | Professional | None | $8.32 | $10.47 | $15.85 |
Wellpoint Setting Professional Modifier None Typical Low $23.99 Median $23.99 Typical High $23.99 | Professional | None | $23.99 | $23.99 | $23.99 |
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 $7.08 Median $7.59 Typical High $9.77 | Professional | 52 · Reduced service | $7.08 | $7.59 | $9.77 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.82 Median $3.09 Typical High $3.89 | Professional | 53 · Discontinued | $2.82 | $3.09 | $3.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.47 Median $11.48 Typical High $14.79 | Professional | 54 · Surgery only | $10.47 | $11.48 | $14.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.09 Median $2.29 Typical High $2.95 | Professional | 55 · Aftercare only | $2.09 | $2.29 | $2.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.41 Median $1.51 Typical High $1.95 | Professional | 56 · Pre-op care only | $1.41 | $1.51 | $1.95 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $7.08 Median $7.59 Typical High $9.33 | Professional | 52 · Reduced service | $7.08 | $7.59 | $9.33 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $2.82 Median $3.09 Typical High $3.80 | Professional | 53 · Discontinued | $2.82 | $3.09 | $3.80 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $10.47 Median $11.48 Typical High $14.13 | Professional | 54 · Surgery only | $10.47 | $11.48 | $14.13 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $2.09 Median $2.29 Typical High $2.82 | Professional | 55 · Aftercare only | $2.09 | $2.29 | $2.82 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $1.41 Median $1.51 Typical High $1.86 | Professional | 56 · Pre-op care only | $1.41 | $1.51 | $1.86 |
Where Texas sits
The same service costs 2.9 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· 23rd of 51
$16.98
RI $26.92NY $9.33
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.