How much rates vary
Facilitymedian $4 · 10th to 90th $2 to $7Professionalmedian $1 · 10th to 90th $1 to $15
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 $1.26 Median $1.26 Typical High $1.38 | Facility | None | $1.26 | $1.26 | $1.38 |
Aetna Setting Professional Modifier None Typical Low $1.20 Median $1.29 Typical High $1.45 | Professional | None | $1.20 | $1.29 | $1.45 |
BCBS Texas Setting Facility Modifier None Typical Low $1.58 Median $2.19 Typical High $5.50 | Facility | None | $1.58 | $2.19 | $5.50 |
BCBS Texas Setting Professional Modifier None Typical Low $0.93 Median $0.93 Typical High $0.93 | Professional | None | $0.93 | $0.93 | $0.93 |
Christus Setting Facility Modifier None Typical Low $6.61 Median $6.61 Typical High $6.61 | Facility | None | $6.61 | $6.61 | $6.61 |
Cigna Setting Professional Modifier None Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | None | $1.00 | $1.00 | $1.00 |
Lucent Health Setting Professional Modifier None Typical Low $10.00 Median $14.79 Typical High $14.79 | Professional | None | $10.00 | $14.79 | $14.79 |
Moda Health Setting Facility Modifier None Typical Low $1.86 Median $4.37 Typical High $4,365.16 | Facility | None | $1.86 | $4.37 | $4,365.16 |
Moda Health Setting Professional Modifier None Typical Low $1.20 Median $1.29 Typical High $1.58 | Professional | None | $1.20 | $1.29 | $1.58 |
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 $1.29 Median $2.00 Typical High $2.04 | Facility | None | $1.29 | $2.00 | $2.04 |
Providence Setting Professional Modifier None Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | None | $1.00 | $1.00 | $1.00 |
United Setting Professional Modifier None Typical Low $0.69 Median $0.89 Typical High $1.17 | Professional | None | $0.69 | $0.89 | $1.17 |
Wellpoint Setting Professional Modifier None Typical Low $0.85 Median $0.85 Typical High $0.85 | Professional | None | $0.85 | $0.85 | $0.85 |
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 $0.59 Median $0.65 Typical High $0.81 | Professional | 52 · Reduced service | $0.59 | $0.65 | $0.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.23 Median $0.26 Typical High $0.33 | Professional | 53 · Discontinued | $0.23 | $0.26 | $0.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.18 Median $0.19 Typical High $0.25 | Professional | 55 · Aftercare only | $0.18 | $0.19 | $0.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.12 Median $0.13 Typical High $0.16 | Professional | 56 · Pre-op care only | $0.12 | $0.13 | $0.16 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $0.59 Median $0.65 Typical High $0.78 | Professional | 52 · Reduced service | $0.59 | $0.65 | $0.78 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.23 Median $0.26 Typical High $0.31 | Professional | 53 · Discontinued | $0.23 | $0.26 | $0.31 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.18 Median $0.19 Typical High $0.24 | Professional | 55 · Aftercare only | $0.18 | $0.19 | $0.24 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.12 Median $0.13 Typical High $0.16 | Professional | 56 · Pre-op care only | $0.12 | $0.13 | $0.16 |
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· 26th of 51
$1.17
HI $2.14UT $0.83
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.