How much rates vary
Facilitymedian $21 · 10th to 90th $18 to $30Professionalmedian $21 · 10th to 90th $10 to $151
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $19.50 Median $20.89 Typical High $21.38 | Facility | None | $19.50 | $20.89 | $21.38 |
Aetna Setting Professional Modifier None Typical Low $19.05 Median $19.50 Typical High $21.38 | Professional | None | $19.05 | $19.50 | $21.38 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $8.91 Median $10.47 Typical High $10.72 | Professional | 52 · Reduced service | $8.91 | $10.47 | $10.72 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.63 Median $4.17 Typical High $4.27 | Professional | 53 · Discontinued | $3.63 | $4.17 | $4.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.69 Median $3.16 Typical High $3.16 | Professional | 55 · Aftercare only | $2.69 | $3.16 | $3.16 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.82 Median $2.09 Typical High $2.14 | Professional | 56 · Pre-op care only | $1.82 | $2.09 | $2.14 |
Cigna Setting Professional Modifier None Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | None | $9.55 | $9.55 | $9.55 |
Lucent Health Setting Professional Modifier None Typical Low $125.89 Median $151.36 Typical High $151.36 | Professional | None | $125.89 | $151.36 | $151.36 |
Moda Health Setting Facility Modifier None Typical Low $17.78 Median $21.38 Typical High $31.62 | Facility | None | $17.78 | $21.38 | $31.62 |
Moda Health Setting Professional Modifier None Typical Low $19.05 Median $19.50 Typical High $21.38 | Professional | None | $19.05 | $19.50 | $21.38 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $9.55 Median $10.47 Typical High $10.72 | Professional | 52 · Reduced service | $9.55 | $10.47 | $10.72 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $3.80 Median $4.17 Typical High $4.27 | Professional | 53 · Discontinued | $3.80 | $4.17 | $4.27 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $2.88 Median $3.16 Typical High $3.16 | Professional | 55 · Aftercare only | $2.88 | $3.16 | $3.16 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $1.91 Median $2.09 Typical High $2.14 | Professional | 56 · Pre-op care only | $1.91 | $2.09 | $2.14 |
Oscar Health Setting Professional Modifier None Typical Low $10.00 Median $10.00 Typical High $19.95 | Professional | None | $10.00 | $10.00 | $19.95 |
Providence Setting Facility Modifier None Typical Low $17.78 Median $25.70 Typical High $31.62 | Facility | None | $17.78 | $25.70 | $31.62 |
Providence Setting Professional Modifier None Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | None | $9.55 | $9.55 | $9.55 |
United Setting Facility Modifier None Typical Low $22.91 Median $22.91 Typical High $26.92 | Facility | None | $22.91 | $22.91 | $26.92 |
United Setting Professional Modifier None Typical Low $8.13 Median $12.59 Typical High $57.54 | Professional | None | $8.13 | $12.59 | $57.54 |
Wellpoint Setting Professional Modifier None Typical Low $25.70 Median $26.92 Typical High $26.92 | Professional | None | $25.70 | $26.92 | $26.92 |
5 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 |
|---|---|---|---|---|---|
Oscar Health Setting Professional Modifier MV Typical Low $25.12 Median $25.12 Typical High $64.57 | Professional | MV | $25.12 | $25.12 | $64.57 |
Oscar Health Setting Professional Modifier PG · Ambulance P to G Typical Low $19.95 Median $19.95 Typical High $19.95 | Professional | PG · Ambulance P to G | $19.95 | $19.95 | $19.95 |
Oscar Health Setting Professional Modifier PP · Ambulance P to P Typical Low $64.57 Median $64.57 Typical High $64.57 | Professional | PP · Ambulance P to P | $64.57 | $64.57 | $64.57 |
Oscar Health Setting Professional Modifier SM · Second surgical opinion Typical Low $10.00 Median $10.00 Typical High $19.95 | Professional | SM · Second surgical opinion | $10.00 | $10.00 | $19.95 |
Oscar Health Setting Professional Modifier SV · Delivered, not used Typical Low $25.12 Median $25.12 Typical High $64.57 | Professional | SV · Delivered, not used | $25.12 | $25.12 | $64.57 |
Where Texas sits
The same service costs 3.0 times more in Montana 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· 5th of 51
$20.89
MT $25.12NY $8.51
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.