How much rates vary
Facilitymedian $3 · 10th to 90th $1 to $6Professionalmedian $1 · 10th to 90th $1 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 $0.65 Median $1.05 Typical High $1.48 | Facility | None | $0.65 | $1.05 | $1.48 |
Aetna Setting Professional Modifier None Typical Low $0.65 Median $0.65 Typical High $0.71 | Professional | None | $0.65 | $0.65 | $0.71 |
BCBS Texas Setting Facility Modifier None Typical Low $1.55 Median $3.98 Typical High $6.46 | Facility | None | $1.55 | $3.98 | $6.46 |
BCBS Texas Setting Professional Modifier None Typical Low $1.07 Median $1.07 Typical High $1.07 | Professional | None | $1.07 | $1.07 | $1.07 |
Cigna Setting Facility Modifier None Typical Low $0.65 Median $1.20 Typical High $2.04 | Facility | None | $0.65 | $1.20 | $2.04 |
Cigna Setting Professional Modifier None Typical Low $0.65 Median $0.65 Typical High $0.65 | Professional | None | $0.65 | $0.65 | $0.65 |
Moda Health Setting Facility Modifier None Typical Low $0.71 Median $1.62 Typical High $6.92 | Facility | None | $0.71 | $1.62 | $6.92 |
Moda Health Setting Professional Modifier None Typical Low $0.65 Median $0.69 Typical High $0.71 | Professional | None | $0.65 | $0.69 | $0.71 |
Molina Setting Professional Modifier None Typical Low $0.65 Median $0.69 Typical High $0.78 | Professional | None | $0.65 | $0.69 | $0.78 |
Providence Setting Facility Modifier None Typical Low $0.65 Median $0.91 Typical High $5.50 | Facility | None | $0.65 | $0.91 | $5.50 |
Providence Setting Professional Modifier None Typical Low $0.65 Median $0.65 Typical High $0.65 | Professional | None | $0.65 | $0.65 | $0.65 |
United Setting Professional Modifier None Typical Low $0.68 Median $0.68 Typical High $0.68 | Professional | None | $0.68 | $0.68 | $0.68 |
Wellpoint Setting Professional Modifier None Typical Low $0.78 Median $0.78 Typical High $0.78 | Professional | None | $0.78 | $0.78 | $0.78 |
12 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 $0.32 Median $0.55 Typical High $0.76 | Facility | 52 · Reduced service | $0.32 | $0.55 | $0.76 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.13 Median $0.22 Typical High $0.30 | Facility | 53 · Discontinued | $0.13 | $0.22 | $0.30 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.10 Median $0.16 Typical High $0.22 | Facility | 55 · Aftercare only | $0.10 | $0.16 | $0.22 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.06 Median $0.10 Typical High $0.15 | Facility | 56 · Pre-op care only | $0.06 | $0.10 | $0.15 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.32 Median $0.32 Typical High $0.35 | Professional | 52 · Reduced service | $0.32 | $0.32 | $0.35 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.13 Median $0.13 Typical High $0.14 | Professional | 53 · Discontinued | $0.13 | $0.13 | $0.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.10 Median $0.10 Typical High $0.11 | Professional | 55 · Aftercare only | $0.10 | $0.10 | $0.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.06 Median $0.06 Typical High $0.07 | Professional | 56 · Pre-op care only | $0.06 | $0.06 | $0.07 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $0.34 Median $0.35 Typical High $0.36 | Professional | 52 · Reduced service | $0.34 | $0.35 | $0.36 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.14 Median $0.14 Typical High $0.14 | Professional | 53 · Discontinued | $0.14 | $0.14 | $0.14 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.10 Median $0.10 Typical High $0.11 | Professional | 55 · Aftercare only | $0.10 | $0.10 | $0.11 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.07 Median $0.07 Typical High $0.07 | Professional | 56 · Pre-op care only | $0.07 | $0.07 | $0.07 |
Where Texas sits
The same service costs 2.6 times more in Texas than in Wyoming. 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· 1st of 51
$1.58
TX $1.58WY $0.62
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.