How much rates vary
Facilitymedian $6 · 10th to 90th $3 to $13Professionalmedian $3 · 10th to 90th $3 to $4
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 $3.55 Median $5.13 Typical High $7.41 | Facility | None | $3.55 | $5.13 | $7.41 |
Aetna Setting Professional Modifier None Typical Low $3.55 Median $3.63 Typical High $3.89 | Professional | None | $3.55 | $3.63 | $3.89 |
BCBS Texas Setting Facility Modifier None Typical Low $2.14 Median $5.75 Typical High $10.96 | Facility | None | $2.14 | $5.75 | $10.96 |
BCBS Texas Setting Professional Modifier None Typical Low $3.16 Median $3.16 Typical High $4.79 | Professional | None | $3.16 | $3.16 | $4.79 |
Cigna Setting Facility Modifier None Typical Low $3.55 Median $8.32 Typical High $11.75 | Facility | None | $3.55 | $8.32 | $11.75 |
Cigna Setting Professional Modifier None Typical Low $3.55 Median $3.55 Typical High $3.55 | Professional | None | $3.55 | $3.55 | $3.55 |
Moda Health Setting Facility Modifier None Typical Low $3.47 Median $8.32 Typical High $26.30 | Facility | None | $3.47 | $8.32 | $26.30 |
Moda Health Setting Professional Modifier None Typical Low $3.39 Median $3.47 Typical High $3.72 | Professional | None | $3.39 | $3.47 | $3.72 |
Molina Setting Professional Modifier None Typical Low $3.89 Median $3.89 Typical High $3.89 | Professional | None | $3.89 | $3.89 | $3.89 |
Providence Setting Facility Modifier None Typical Low $3.55 Median $5.13 Typical High $30.20 | Facility | None | $3.55 | $5.13 | $30.20 |
Providence Setting Professional Modifier None Typical Low $3.55 Median $3.55 Typical High $3.55 | Professional | None | $3.55 | $3.55 | $3.55 |
United Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | None | $3.39 | $3.39 | $3.39 |
Wellpoint Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | None | $3.39 | $3.39 | $3.39 |
14 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 $1.78 Median $2.75 Typical High $3.72 | Facility | 52 · Reduced service | $1.78 | $2.75 | $3.72 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.71 Median $1.10 Typical High $1.48 | Facility | 53 · Discontinued | $0.71 | $1.10 | $1.48 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.52 Median $0.81 Typical High $1.12 | Facility | 55 · Aftercare only | $0.52 | $0.81 | $1.12 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.36 Median $0.55 Typical High $0.76 | Facility | 56 · Pre-op care only | $0.36 | $0.55 | $0.76 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $1.78 Median $1.82 Typical High $1.95 | Professional | 52 · Reduced service | $1.78 | $1.82 | $1.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.71 Median $0.72 Typical High $0.78 | Professional | 53 · Discontinued | $0.71 | $0.72 | $0.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.52 Median $0.54 Typical High $0.59 | Professional | 55 · Aftercare only | $0.52 | $0.54 | $0.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.36 Median $0.36 Typical High $0.39 | Professional | 56 · Pre-op care only | $0.36 | $0.36 | $0.39 |
Moda Health Setting Facility Modifier JW · Drug discarded Typical Low $10.72 Median $19.05 Typical High $28.18 | Facility | JW · Drug discarded | $10.72 | $19.05 | $28.18 |
Moda Health Setting Facility Modifier JZ · No drug discarded Typical Low $5.89 Median $8.13 Typical High $19.50 | Facility | JZ · No drug discarded | $5.89 | $8.13 | $19.50 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1.70 Median $1.74 Typical High $1.78 | Professional | 52 · Reduced service | $1.70 | $1.74 | $1.78 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.68 Median $0.69 Typical High $0.71 | Professional | 53 · Discontinued | $0.68 | $0.69 | $0.71 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.51 Median $0.52 Typical High $0.52 | Professional | 55 · Aftercare only | $0.51 | $0.52 | $0.52 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.34 Median $0.35 Typical High $0.36 | Professional | 56 · Pre-op care only | $0.34 | $0.35 | $0.36 |
Where Texas sits
The same service costs 4.0 times more in Oklahoma than in Maryland. 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· 6th of 51
$4.79
OK $13.49MD $3.39
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.