How much rates vary
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 $0.50 Median $0.50 Typical High $0.55 | Facility | None | $0.50 | $0.50 | $0.55 |
Aetna Setting Professional Modifier None Typical Low $0.47 Median $0.51 Typical High $0.65 | Professional | None | $0.47 | $0.51 | $0.65 |
BCBS Texas Setting Facility Modifier None Typical Low $0.63 Median $0.81 Typical High $2.09 | Facility | None | $0.63 | $0.81 | $2.09 |
BCBS Texas Setting Professional Modifier None Typical Low $0.37 Median $0.37 Typical High $0.37 | Professional | None | $0.37 | $0.37 | $0.37 |
Cigna Setting Professional Modifier None Typical Low $0.40 Median $0.40 Typical High $0.40 | Professional | None | $0.40 | $0.40 | $0.40 |
Lucent Health Setting Professional Modifier None Typical Low $3.98 Median $6.03 Typical High $6.03 | Professional | None | $3.98 | $6.03 | $6.03 |
Moda Health Setting Facility Modifier None Typical Low $0.50 Median $0.74 Typical High $0.89 | Facility | None | $0.50 | $0.74 | $0.89 |
Moda Health Setting Professional Modifier None Typical Low $0.47 Median $0.51 Typical High $0.68 | Professional | None | $0.47 | $0.51 | $0.68 |
Molina Setting Professional Modifier None Typical Low $81.28 Median $81.28 Typical High $81.28 | Professional | None | $81.28 | $81.28 | $81.28 |
Providence Setting Facility Modifier None Typical Low $0.51 Median $0.79 Typical High $0.81 | Facility | None | $0.51 | $0.79 | $0.81 |
Providence Setting Professional Modifier None Typical Low $0.40 Median $0.40 Typical High $0.40 | Professional | None | $0.40 | $0.40 | $0.40 |
United Setting Professional Modifier None Typical Low $0.28 Median $0.36 Typical High $0.48 | Professional | None | $0.28 | $0.36 | $0.48 |
Wellpoint Setting Professional Modifier None Typical Low $0.38 Median $0.38 Typical High $0.38 | Professional | None | $0.38 | $0.38 | $0.38 |
8 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 $0.24 Median $0.26 Typical High $0.33 | Professional | 52 · Reduced service | $0.24 | $0.26 | $0.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.09 Median $0.10 Typical High $0.13 | Professional | 53 · Discontinued | $0.09 | $0.10 | $0.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.07 Median $0.08 Typical High $0.10 | Professional | 55 · Aftercare only | $0.07 | $0.08 | $0.10 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.05 Median $0.05 Typical High $0.07 | Professional | 56 · Pre-op care only | $0.05 | $0.05 | $0.07 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $0.24 Median $0.26 Typical High $0.31 | Professional | 52 · Reduced service | $0.24 | $0.26 | $0.31 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.09 Median $0.10 Typical High $0.13 | Professional | 53 · Discontinued | $0.09 | $0.10 | $0.13 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.07 Median $0.08 Typical High $0.09 | Professional | 55 · Aftercare only | $0.07 | $0.08 | $0.09 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.05 Median $0.05 Typical High $0.06 | Professional | 56 · Pre-op care only | $0.05 | $0.05 | $0.06 |
Where Texas sits
The same service costs 2.6 times more in Hawaii than in Utah. 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· 39th of 51
$0.40
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.