How much rates vary
Facilitymedian $427 · 10th to 90th $186 to $832Professionalmedian $282 · 10th to 90th $240 to $295
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 $281.84 Median $380.19 Typical High $588.84 | Facility | None | $281.84 | $380.19 | $588.84 |
Aetna Setting Professional Modifier None Typical Low $281.84 Median $281.84 Typical High $288.40 | Professional | None | $281.84 | $281.84 | $288.40 |
Ambetter Setting Professional Modifier None Typical Low $380.19 Median $380.19 Typical High $380.19 | Professional | None | $380.19 | $380.19 | $380.19 |
BCBS Texas Setting Facility Modifier None Typical Low $169.82 Median $426.58 Typical High $794.33 | Facility | None | $169.82 | $426.58 | $794.33 |
BCBS Texas Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | None | $239.88 | $239.88 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $281.84 Median $524.81 Typical High $891.25 | Facility | None | $281.84 | $524.81 | $891.25 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | None | $281.84 | $281.84 | $281.84 |
Lucent Health Setting Professional Modifier None Typical Low $263.03 Median $263.03 Typical High $489.78 | Professional | None | $263.03 | $263.03 | $489.78 |
Moda Health Setting Facility Modifier None Typical Low $269.15 Median $323.59 Typical High $562.34 | Facility | None | $269.15 | $323.59 | $562.34 |
Moda Health Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $281.84 | Professional | None | $269.15 | $269.15 | $281.84 |
Molina Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $295.12 | Professional | None | $257.04 | $257.04 | $295.12 |
Oscar Health Setting Professional Modifier None Typical Low $288.40 Median $478.63 Typical High $1,000.00 | Professional | None | $288.40 | $478.63 | $1,000.00 |
Providence Setting Facility Modifier None Typical Low $269.15 Median $398.11 Typical High $2,398.83 | Facility | None | $269.15 | $398.11 | $2,398.83 |
Providence Setting Professional Modifier None Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | None | $281.84 | $281.84 | $281.84 |
United Setting Facility Modifier None Typical Low $281.84 Median $281.84 Typical High $281.84 | Facility | None | $281.84 | $281.84 | $281.84 |
United Setting Professional Modifier None Typical Low $269.15 Median $281.84 Typical High $302.00 | Professional | None | $269.15 | $281.84 | $302.00 |
Wellpoint Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $269.15 | Professional | None | $269.15 | $269.15 | $269.15 |
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 $138.04 Median $177.83 Typical High $295.12 | Facility | 52 · Reduced service | $138.04 | $177.83 | $295.12 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $56.23 Median $70.79 Typical High $117.49 | Facility | 53 · Discontinued | $56.23 | $70.79 | $117.49 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $41.69 Median $52.48 Typical High $87.10 | Facility | 55 · Aftercare only | $41.69 | $52.48 | $87.10 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $28.18 Median $35.48 Typical High $58.88 | Facility | 56 · Pre-op care only | $28.18 | $35.48 | $58.88 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $138.04 Median $138.04 Typical High $144.54 | Professional | 52 · Reduced service | $138.04 | $138.04 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $56.23 Typical High $57.54 | Professional | 53 · Discontinued | $56.23 | $56.23 | $57.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $41.69 Typical High $42.66 | Professional | 55 · Aftercare only | $41.69 | $41.69 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $28.18 Typical High $28.84 | Professional | 56 · Pre-op care only | $28.18 | $28.18 | $28.84 |
Ambetter Setting Professional Modifier JW · Drug discarded Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | JW · Drug discarded | $302.00 | $302.00 | $302.00 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $134.90 Median $134.90 Typical High $138.04 | Professional | 52 · Reduced service | $134.90 | $134.90 | $138.04 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $53.70 Median $53.70 Typical High $54.95 | Professional | 53 · Discontinued | $53.70 | $53.70 | $54.95 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $40.74 Median $40.74 Typical High $41.69 | Professional | 55 · Aftercare only | $40.74 | $40.74 | $41.69 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $26.92 Median $26.92 Typical High $27.54 | Professional | 56 · Pre-op care only | $26.92 | $26.92 | $27.54 |
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· 39th of 51
$282
AK $339NC $275
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.