How much rates vary
Facilitymedian $162 · 10th to 90th $120 to $525Professionalmedian $126 · 10th to 90th $91 to $204
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 $95.50 Median $112.20 Typical High $125.89 | Facility | None | $95.50 | $112.20 | $125.89 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $117.49 Typical High $169.82 | Professional | None | $89.13 | $117.49 | $169.82 |
Ambetter Setting Professional Modifier None Typical Low $128.82 Median $151.36 Typical High $162.18 | Professional | None | $128.82 | $151.36 | $162.18 |
BCBS Texas Setting Facility Modifier None Typical Low $162.18 Median $363.08 Typical High $645.65 | Facility | None | $162.18 | $363.08 | $645.65 |
BCBS Texas Setting Professional Modifier None Typical Low $91.20 Median $123.03 Typical High $181.97 | Professional | None | $91.20 | $123.03 | $181.97 |
Baylor Scott & White Setting Professional Modifier None Typical Low $125.89 Median $147.91 Typical High $154.88 | Professional | None | $125.89 | $147.91 | $154.88 |
Christus Setting Facility Modifier None Typical Low $131.83 Median $131.83 Typical High $131.83 | Facility | None | $131.83 | $131.83 | $131.83 |
Cigna Setting Facility Modifier None Typical Low $125.89 Median $125.89 Typical High $125.89 | Facility | None | $125.89 | $125.89 | $125.89 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $128.82 Typical High $194.98 | Professional | None | $93.33 | $128.82 | $194.98 |
Health Smart Setting Professional Modifier None Typical Low $154.88 Median $173.78 Typical High $257.04 | Professional | None | $154.88 | $173.78 | $257.04 |
Lucent Health Setting Professional Modifier None Typical Low $204.17 Median $954.99 Typical High $954.99 | Professional | None | $204.17 | $954.99 | $954.99 |
Moda Health Setting Facility Modifier None Typical Low $97.72 Median $131.83 Typical High $173.78 | Facility | None | $97.72 | $131.83 | $173.78 |
Moda Health Setting Professional Modifier None Typical Low $89.13 Median $117.49 Typical High $186.21 | Professional | None | $89.13 | $117.49 | $186.21 |
Molina Setting Professional Modifier None Typical Low $30.20 Median $87.10 Typical High $93.33 | Professional | None | $30.20 | $87.10 | $93.33 |
Oscar Health Setting Professional Modifier None Typical Low $147.91 Median $173.78 Typical High $323.59 | Professional | None | $147.91 | $173.78 | $323.59 |
Providence Setting Facility Modifier None Typical Low $97.72 Median $134.90 Typical High $173.78 | Facility | None | $97.72 | $134.90 | $173.78 |
Providence Setting Professional Modifier None Typical Low $93.33 Median $125.89 Typical High $194.98 | Professional | None | $93.33 | $125.89 | $194.98 |
United Setting Professional Modifier None Typical Low $93.33 Median $128.82 Typical High $181.97 | Professional | None | $93.33 | $128.82 | $181.97 |
Wellpoint Setting Professional Modifier None Typical Low $154.88 Median $154.88 Typical High $154.88 | Professional | None | $154.88 | $154.88 | $154.88 |
16 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 $44.67 Median $58.88 Typical High $70.79 | Professional | 52 · Reduced service | $44.67 | $58.88 | $70.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $17.38 Typical High $21.38 | Professional | 55 · Aftercare only | $13.49 | $17.38 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $11.75 Typical High $14.13 | Professional | 56 · Pre-op care only | $8.91 | $11.75 | $14.13 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $128.82 Median $151.36 Typical High $165.96 | Professional | 25 · Same-day visit | $128.82 | $151.36 | $165.96 |
Ambetter Setting Professional Modifier 33 · Preventive service Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | 33 · Preventive service | $151.36 | $151.36 | $151.36 |
Ambetter Setting Professional Modifier FP · Family planning Typical Low $102.33 Median $102.33 Typical High $102.33 | Professional | FP · Family planning | $102.33 | $102.33 | $102.33 |
Ambetter Setting Professional Modifier GA · Liability notice issued Typical Low $213.80 Median $213.80 Typical High $213.80 | Professional | GA · Liability notice issued | $213.80 | $213.80 | $213.80 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $97.72 Median $173.78 Typical High $173.78 | Professional | GC · Resident with teaching physician | $97.72 | $173.78 | $173.78 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $107.15 Median $107.15 Typical High $107.15 | Professional | GE · Resident, primary care exception | $107.15 | $107.15 | $107.15 |
Ambetter Setting Professional Modifier Q6 · Substitute physician, paid per time Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | Q6 · Substitute physician, paid per time | $151.36 | $151.36 | $151.36 |
Ambetter Setting Professional Modifier SA · Nurse practitioner Typical Low $109.65 Median $128.82 Typical High $158.49 | Professional | SA · Nurse practitioner | $109.65 | $128.82 | $158.49 |
Moda Health Setting Professional Modifier 25 · Same-day visit Typical Low $120.23 Median $190.55 Typical High $501.19 | Professional | 25 · Same-day visit | $120.23 | $190.55 | $501.19 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $44.67 Median $58.88 Typical High $67.61 | Professional | 52 · Reduced service | $44.67 | $58.88 | $67.61 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $17.38 Typical High $19.95 | Professional | 55 · Aftercare only | $13.49 | $17.38 | $19.95 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $11.75 Typical High $13.49 | Professional | 56 · Pre-op care only | $8.91 | $11.75 | $13.49 |
Moda Health Setting Professional Modifier SA · Nurse practitioner Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | SA · Nurse practitioner | $162.18 | $162.18 | $162.18 |
Where Texas sits
The same service costs 2.7 times more in Alaska than in Washington, DC. 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· 45th of 51
$126
AK $295DC $110
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.