How much rates vary
Facilitymedian $2 · 10th to 90th $1 to $6Professionalmedian $2 · 10th to 90th $1 to $2
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 $2.19 Median $2.82 Typical High $4.37 | Facility | None | $2.19 | $2.82 | $4.37 |
Aetna Setting Professional Modifier None Typical Low $2.19 Median $2.19 Typical High $2.40 | Professional | None | $2.19 | $2.19 | $2.40 |
BCBS Texas Setting Facility Modifier None Typical Low $0.58 Median $1.26 Typical High $2.51 | Facility | None | $0.58 | $1.26 | $2.51 |
BCBS Texas Setting Professional Modifier None Typical Low $1.45 Median $1.45 Typical High $1.45 | Professional | None | $1.45 | $1.45 | $1.45 |
Cigna Setting Facility Modifier None Typical Low $2.19 Median $4.07 Typical High $6.92 | Facility | None | $2.19 | $4.07 | $6.92 |
Cigna Setting Professional Modifier None Typical Low $2.19 Median $2.19 Typical High $2.19 | Professional | None | $2.19 | $2.19 | $2.19 |
Moda Health Setting Facility Modifier None Typical Low $2.04 Median $5.37 Typical High $8.51 | Facility | None | $2.04 | $5.37 | $8.51 |
Moda Health Setting Professional Modifier None Typical Low $2.04 Median $2.04 Typical High $2.24 | Professional | None | $2.04 | $2.04 | $2.24 |
Molina Setting Professional Modifier None Typical Low $2.45 Median $2.45 Typical High $2.45 | Professional | None | $2.45 | $2.45 | $2.45 |
Providence Setting Facility Modifier None Typical Low $2.19 Median $3.16 Typical High $18.62 | Facility | None | $2.19 | $3.16 | $18.62 |
Providence Setting Professional Modifier None Typical Low $2.19 Median $2.19 Typical High $2.19 | Professional | None | $2.19 | $2.19 | $2.19 |
United Setting Professional Modifier None Typical Low $2.04 Median $2.04 Typical High $2.04 | Professional | None | $2.04 | $2.04 | $2.04 |
Wellpoint Setting Professional Modifier None Typical Low $2.04 Median $2.04 Typical High $2.04 | Professional | None | $2.04 | $2.04 | $2.04 |
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 $1.10 Median $1.62 Typical High $2.19 | Facility | 52 · Reduced service | $1.10 | $1.62 | $2.19 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.44 Median $0.65 Typical High $0.87 | Facility | 53 · Discontinued | $0.44 | $0.65 | $0.87 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.33 Median $0.48 Typical High $0.66 | Facility | 55 · Aftercare only | $0.33 | $0.48 | $0.66 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.22 Median $0.32 Typical High $0.44 | Facility | 56 · Pre-op care only | $0.22 | $0.32 | $0.44 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $1.10 Median $1.12 Typical High $1.20 | Professional | 52 · Reduced service | $1.10 | $1.12 | $1.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.44 Median $0.44 Typical High $0.48 | Professional | 53 · Discontinued | $0.44 | $0.44 | $0.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.33 Median $0.33 Typical High $0.36 | Professional | 55 · Aftercare only | $0.33 | $0.33 | $0.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.22 Median $0.22 Typical High $0.24 | Professional | 56 · Pre-op care only | $0.22 | $0.22 | $0.24 |
Moda Health Setting Facility Modifier 59 · Distinct service Typical Low $9.55 Median $9.55 Typical High $10.00 | Facility | 59 · Distinct service | $9.55 | $9.55 | $10.00 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1.00 Median $1.02 Typical High $1.05 | Professional | 52 · Reduced service | $1.00 | $1.02 | $1.05 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.40 Median $0.41 Typical High $0.42 | Professional | 53 · Discontinued | $0.40 | $0.41 | $0.42 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.30 Median $0.31 Typical High $0.32 | Professional | 55 · Aftercare only | $0.30 | $0.31 | $0.32 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.20 Median $0.20 Typical High $0.21 | Professional | 56 · Pre-op care only | $0.20 | $0.20 | $0.21 |
Where Texas sits
Rates are fairly even across states for this service. 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· 51st of 51
$2.04
AK $3.02TX $2.04
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.