How much rates vary
Facilitymedian $3 · 10th to 90th $1 to $5Professionalmedian $0 · 10th to 90th $0 to $1
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 $0.39 Median $0.72 Typical High $1.05 | Facility | None | $0.39 | $0.72 | $1.05 |
Aetna Setting Professional Modifier None Typical Low $0.39 Median $0.40 Typical High $0.44 | Professional | None | $0.39 | $0.40 | $0.44 |
BCBS Texas Setting Facility Modifier None Typical Low $1.35 Median $3.39 Typical High $5.75 | Facility | None | $1.35 | $3.39 | $5.75 |
BCBS Texas Setting Professional Modifier None Typical Low $0.69 Median $0.69 Typical High $0.69 | Professional | None | $0.69 | $0.69 | $0.69 |
Baylor Scott & White Setting Facility Modifier None Typical Low $0.48 Median $0.68 Typical High $6.92 | Facility | None | $0.48 | $0.68 | $6.92 |
Cigna Setting Facility Modifier None Typical Low $0.39 Median $0.87 Typical High $1.23 | Facility | None | $0.39 | $0.87 | $1.23 |
Cigna Setting Professional Modifier None Typical Low $0.39 Median $0.39 Typical High $0.39 | Professional | None | $0.39 | $0.39 | $0.39 |
Moda Health Setting Facility Modifier None Typical Low $0.65 Median $2.45 Typical High $3.72 | Facility | None | $0.65 | $2.45 | $3.72 |
Moda Health Setting Professional Modifier None Typical Low $0.48 Median $0.48 Typical High $0.54 | Professional | None | $0.48 | $0.48 | $0.54 |
Molina Setting Professional Modifier None Typical Low $0.28 Median $0.34 Typical High $0.37 | Professional | None | $0.28 | $0.34 | $0.37 |
Providence Setting Facility Modifier None Typical Low $0.39 Median $0.56 Typical High $3.31 | Facility | None | $0.39 | $0.56 | $3.31 |
Providence Setting Professional Modifier None Typical Low $0.39 Median $0.39 Typical High $0.39 | Professional | None | $0.39 | $0.39 | $0.39 |
United Setting Professional Modifier None Typical Low $0.48 Median $0.48 Typical High $0.48 | Professional | None | $0.48 | $0.48 | $0.48 |
Wellpoint Setting Professional Modifier None Typical Low $0.52 Median $0.52 Typical High $0.52 | Professional | None | $0.52 | $0.52 | $0.52 |
13 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 Facility Modifier 52 · Reduced service Typical Low $0.20 Median $0.38 Typical High $0.52 | Facility | 52 · Reduced service | $0.20 | $0.38 | $0.52 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.08 Median $0.14 Typical High $0.21 | Facility | 53 · Discontinued | $0.08 | $0.14 | $0.21 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.06 Median $0.11 Typical High $0.16 | Facility | 55 · Aftercare only | $0.06 | $0.11 | $0.16 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.07 Typical High $0.10 | Facility | 56 · Pre-op care only | $0.04 | $0.07 | $0.10 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.20 Median $0.20 Typical High $0.22 | Professional | 52 · Reduced service | $0.20 | $0.20 | $0.22 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.08 Median $0.08 Typical High $0.09 | Professional | 53 · Discontinued | $0.08 | $0.08 | $0.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.06 Median $0.06 Typical High $0.06 | Professional | 55 · Aftercare only | $0.06 | $0.06 | $0.06 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.04 Median $0.04 Typical High $0.04 | Professional | 56 · Pre-op care only | $0.04 | $0.04 | $0.04 |
Moda Health Setting Facility Modifier JZ · No drug discarded Typical Low $2.45 Median $5.13 Typical High $6.61 | Facility | JZ · No drug discarded | $2.45 | $5.13 | $6.61 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $0.24 Median $0.24 Typical High $0.25 | Professional | 52 · Reduced service | $0.24 | $0.24 | $0.25 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.10 Median $0.10 Typical High $0.10 | Professional | 53 · Discontinued | $0.10 | $0.10 | $0.10 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.07 Median $0.07 Typical High $0.08 | Professional | 55 · Aftercare only | $0.07 | $0.07 | $0.08 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.05 Median $0.05 Typical High $0.05 | Professional | 56 · Pre-op care only | $0.05 | $0.05 | $0.05 |
Where Texas sits
The same service costs 5.2 times more in Wyoming than in Georgia. 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· 2nd of 51
$1.55
WY $2.04GA $0.39
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.