How much rates vary
Facilitymedian $2 · 10th to 90th $0 to $5Professionalmedian $1 · 10th to 90th $1 to $19
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 $1.58 Median $1.58 Typical High $1.74 | Facility | None | $1.58 | $1.58 | $1.74 |
Aetna Setting Professional Modifier None Typical Low $1.48 Median $1.62 Typical High $1.82 | Professional | None | $1.48 | $1.62 | $1.82 |
Ambetter Setting Professional Modifier None Typical Low $1.07 Median $1.48 Typical High $1.86 | Professional | None | $1.07 | $1.48 | $1.86 |
BCBS Texas Setting Facility Modifier None Typical Low $1.95 Median $2.63 Typical High $6.76 | Facility | None | $1.95 | $2.63 | $6.76 |
BCBS Texas Setting Professional Modifier None Typical Low $1.17 Median $1.17 Typical High $1.17 | Professional | None | $1.17 | $1.17 | $1.17 |
Christus Setting Facility Modifier None Typical Low $0.13 Median $0.13 Typical High $0.13 | Facility | None | $0.13 | $0.13 | $0.13 |
Cigna Setting Professional Modifier None Typical Low $1.26 Median $1.26 Typical High $1.26 | Professional | None | $1.26 | $1.26 | $1.26 |
Health Smart Setting Professional Modifier None Typical Low $1.48 Median $2.34 Typical High $2.57 | Professional | None | $1.48 | $2.34 | $2.57 |
Lucent Health Setting Professional Modifier None Typical Low $12.59 Median $12.59 Typical High $18.62 | Professional | None | $12.59 | $12.59 | $18.62 |
Moda Health Setting Facility Modifier None Typical Low $1.58 Median $2.14 Typical High $2.57 | Facility | None | $1.58 | $2.14 | $2.57 |
Moda Health Setting Professional Modifier None Typical Low $1.48 Median $1.62 Typical High $1.86 | Professional | None | $1.48 | $1.62 | $1.86 |
Molina Setting Professional Modifier None Typical Low $1.74 Median $1.74 Typical High $2.00 | Professional | None | $1.74 | $1.74 | $2.00 |
Providence Setting Facility Modifier None Typical Low $1.62 Median $2.51 Typical High $2.57 | Facility | None | $1.62 | $2.51 | $2.57 |
Providence Setting Professional Modifier None Typical Low $1.26 Median $1.26 Typical High $1.26 | Professional | None | $1.26 | $1.26 | $1.26 |
United Setting Professional Modifier None Typical Low $0.87 Median $1.12 Typical High $1.48 | Professional | None | $0.87 | $1.12 | $1.48 |
Wellpoint Setting Professional Modifier None Typical Low $1.10 Median $1.10 Typical High $1.10 | Professional | None | $1.10 | $1.10 | $1.10 |
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 $0.74 Median $0.81 Typical High $1.02 | Professional | 52 · Reduced service | $0.74 | $0.81 | $1.02 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.30 Median $0.32 Typical High $0.42 | Professional | 53 · Discontinued | $0.30 | $0.32 | $0.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.22 Median $0.24 Typical High $0.31 | Professional | 55 · Aftercare only | $0.22 | $0.24 | $0.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.15 Median $0.16 Typical High $0.21 | Professional | 56 · Pre-op care only | $0.15 | $0.16 | $0.21 |
Ambetter Setting Professional Modifier A1 · Dressing, 1 wound Typical Low $1.74 Median $1.74 Typical High $1.74 | Professional | A1 · Dressing, 1 wound | $1.74 | $1.74 | $1.74 |
Ambetter Setting Professional Modifier A2 · Dressing, 2 wounds Typical Low $1.74 Median $1.74 Typical High $1.74 | Professional | A2 · Dressing, 2 wounds | $1.74 | $1.74 | $1.74 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $0.74 Median $0.81 Typical High $0.98 | Professional | 52 · Reduced service | $0.74 | $0.81 | $0.98 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.30 Median $0.32 Typical High $0.39 | Professional | 53 · Discontinued | $0.30 | $0.32 | $0.39 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.22 Median $0.24 Typical High $0.30 | Professional | 55 · Aftercare only | $0.22 | $0.24 | $0.30 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.15 Median $0.16 Typical High $0.20 | Professional | 56 · Pre-op care only | $0.15 | $0.16 | $0.20 |
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· 30th of 51
$1.41
HI $2.69UT $1.05
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.