How much rates vary
Facilitymedian $21 · 10th to 90th $8 to $186Professionalmedian $8 · 10th to 90th $6 to $102
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 $8.71 Median $8.71 Typical High $9.55 | Facility | None | $8.71 | $8.71 | $9.55 |
Aetna Setting Professional Modifier None Typical Low $8.13 Median $8.71 Typical High $10.96 | Professional | None | $8.13 | $8.71 | $10.96 |
Ambetter Setting Professional Modifier None Typical Low $8.13 Median $9.55 Typical High $9.55 | Professional | None | $8.13 | $9.55 | $9.55 |
BCBS Texas Setting Facility Modifier None Typical Low $10.72 Median $16.22 Typical High $38.02 | Facility | None | $10.72 | $16.22 | $38.02 |
BCBS Texas Setting Professional Modifier None Typical Low $6.46 Median $7.24 Typical High $7.24 | Professional | None | $6.46 | $7.24 | $7.24 |
Christus Setting Facility Modifier None Typical Low $186.21 Median $186.21 Typical High $186.21 | Facility | None | $186.21 | $186.21 | $186.21 |
Cigna Setting Facility Modifier None Typical Low $8.13 Median $8.13 Typical High $8.51 | Facility | None | $8.13 | $8.13 | $8.51 |
Cigna Setting Professional Modifier None Typical Low $6.92 Median $6.92 Typical High $8.13 | Professional | None | $6.92 | $6.92 | $8.13 |
Lucent Health Setting Professional Modifier None Typical Low $67.61 Median $102.33 Typical High $102.33 | Professional | None | $67.61 | $102.33 | $102.33 |
Moda Health Setting Facility Modifier None Typical Low $2.75 Median $9.55 Typical High $13.80 | Facility | None | $2.75 | $9.55 | $13.80 |
Moda Health Setting Professional Modifier None Typical Low $8.13 Median $8.71 Typical High $11.75 | Professional | None | $8.13 | $8.71 | $11.75 |
Molina Setting Professional Modifier None Typical Low $7.76 Median $7.76 Typical High $81.28 | Professional | None | $7.76 | $7.76 | $81.28 |
Providence Setting Facility Modifier None Typical Low $8.13 Median $8.32 Typical High $13.80 | Facility | None | $8.13 | $8.32 | $13.80 |
Providence Setting Professional Modifier None Typical Low $6.92 Median $6.92 Typical High $8.13 | Professional | None | $6.92 | $6.92 | $8.13 |
United Setting Professional Modifier None Typical Low $4.37 Median $6.17 Typical High $8.71 | Professional | None | $4.37 | $6.17 | $8.71 |
Wellpoint Setting Professional Modifier None Typical Low $6.92 Median $6.92 Typical High $6.92 | Professional | None | $6.92 | $6.92 | $6.92 |
9 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 $4.07 Median $4.37 Typical High $5.50 | Professional | 52 · Reduced service | $4.07 | $4.37 | $5.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.62 Median $1.78 Typical High $2.19 | Professional | 53 · Discontinued | $1.62 | $1.78 | $2.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.23 Median $1.32 Typical High $1.62 | Professional | 55 · Aftercare only | $1.23 | $1.32 | $1.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.81 Median $0.87 Typical High $1.10 | Professional | 56 · Pre-op care only | $0.81 | $0.87 | $1.10 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $9.55 Median $9.55 Typical High $9.55 | Professional | KX · Policy requirements met | $9.55 | $9.55 | $9.55 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $4.07 Median $4.37 Typical High $5.50 | Professional | 52 · Reduced service | $4.07 | $4.37 | $5.50 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $1.62 Median $1.78 Typical High $2.19 | Professional | 53 · Discontinued | $1.62 | $1.78 | $2.19 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $1.23 Median $1.32 Typical High $1.62 | Professional | 55 · Aftercare only | $1.23 | $1.32 | $1.62 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.81 Median $0.87 Typical High $1.10 | Professional | 56 · Pre-op care only | $0.81 | $0.87 | $1.10 |
Where Texas sits
The same service costs 2.2 times more in Hawaii than in Maine. 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
$8.71
HI $15.49ME $6.92
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.