How much rates vary
Facilitymedian $4 · 10th to 90th $2 to $13Professionalmedian $3 · 10th to 90th $1 to $3
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 $2.88 Median $3.39 Typical High $5.89 | Facility | None | $2.88 | $3.39 | $5.89 |
Aetna Setting Professional Modifier None Typical Low $2.95 Median $2.95 Typical High $3.02 | Professional | None | $2.95 | $2.95 | $3.02 |
Ambetter Setting Professional Modifier None Typical Low $2.29 Median $3.47 Typical High $3.47 | Professional | None | $2.29 | $3.47 | $3.47 |
BCBS Texas Setting Facility Modifier None Typical Low $1.29 Median $3.24 Typical High $6.03 | Facility | None | $1.29 | $3.24 | $6.03 |
BCBS Texas Setting Professional Modifier None Typical Low $1.20 Median $1.20 Typical High $1.20 | Professional | None | $1.20 | $1.20 | $1.20 |
Baylor Scott & White Setting Facility Modifier None Typical Low $2.00 Median $2.69 Typical High $6.61 | Facility | None | $2.00 | $2.69 | $6.61 |
Cigna Setting Facility Modifier None Typical Low $2.95 Median $5.50 Typical High $9.33 | Facility | None | $2.95 | $5.50 | $9.33 |
Cigna Setting Professional Modifier None Typical Low $2.95 Median $2.95 Typical High $2.95 | Professional | None | $2.95 | $2.95 | $2.95 |
Lucent Health Setting Professional Modifier None Typical Low $2.51 Median $2.51 Typical High $4.79 | Professional | None | $2.51 | $2.51 | $4.79 |
Moda Health Setting Facility Modifier None Typical Low $2.75 Median $9.12 Typical High $25.70 | Facility | None | $2.75 | $9.12 | $25.70 |
Moda Health Setting Professional Modifier None Typical Low $2.69 Median $2.75 Typical High $3.02 | Professional | None | $2.69 | $2.75 | $3.02 |
Molina Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.89 | Professional | None | $3.39 | $3.39 | $3.89 |
Oscar Health Setting Professional Modifier None Typical Low $2.82 Median $4.79 Typical High $9.77 | Professional | None | $2.82 | $4.79 | $9.77 |
Providence Setting Facility Modifier None Typical Low $2.69 Median $4.17 Typical High $25.12 | Facility | None | $2.69 | $4.17 | $25.12 |
Providence Setting Professional Modifier None Typical Low $2.95 Median $2.95 Typical High $2.95 | Professional | None | $2.95 | $2.95 | $2.95 |
United Setting Professional Modifier None Typical Low $2.69 Median $2.82 Typical High $3.02 | Professional | None | $2.69 | $2.82 | $3.02 |
Wellpoint Setting Professional Modifier None Typical Low $2.57 Median $2.57 Typical High $2.57 | Professional | None | $2.57 | $2.57 | $2.57 |
18 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 $1.45 Median $1.78 Typical High $2.95 | Facility | 52 · Reduced service | $1.45 | $1.78 | $2.95 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $0.58 Median $0.71 Typical High $1.17 | Facility | 53 · Discontinued | $0.58 | $0.71 | $1.17 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $0.43 Median $0.52 Typical High $0.87 | Facility | 55 · Aftercare only | $0.43 | $0.52 | $0.87 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $0.28 Median $0.35 Typical High $0.58 | Facility | 56 · Pre-op care only | $0.28 | $0.35 | $0.58 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $1.48 Median $1.48 Typical High $1.51 | Professional | 52 · Reduced service | $1.48 | $1.48 | $1.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.59 Median $0.59 Typical High $0.62 | Professional | 53 · Discontinued | $0.59 | $0.59 | $0.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.44 Median $0.44 Typical High $0.45 | Professional | 55 · Aftercare only | $0.44 | $0.44 | $0.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.28 Median $0.28 Typical High $0.30 | Professional | 56 · Pre-op care only | $0.28 | $0.28 | $0.30 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $2.69 Median $2.69 Typical High $2.69 | Professional | GC · Resident with teaching physician | $2.69 | $2.69 | $2.69 |
Ambetter Setting Professional Modifier JZ · No drug discarded Typical Low $2.69 Median $2.69 Typical High $2.95 | Professional | JZ · No drug discarded | $2.69 | $2.69 | $2.95 |
Moda Health Setting Facility Modifier 52 · Reduced service Typical Low $1.35 Median $1.62 Typical High $2.75 | Facility | 52 · Reduced service | $1.35 | $1.62 | $2.75 |
Moda Health Setting Facility Modifier 53 · Discontinued Typical Low $0.54 Median $0.65 Typical High $1.12 | Facility | 53 · Discontinued | $0.54 | $0.65 | $1.12 |
Moda Health Setting Facility Modifier 55 · Aftercare only Typical Low $0.40 Median $0.49 Typical High $0.83 | Facility | 55 · Aftercare only | $0.40 | $0.49 | $0.83 |
Moda Health Setting Facility Modifier 56 · Pre-op care only Typical Low $0.27 Median $0.32 Typical High $0.56 | Facility | 56 · Pre-op care only | $0.27 | $0.32 | $0.56 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1.35 Median $1.35 Typical High $1.38 | Professional | 52 · Reduced service | $1.35 | $1.35 | $1.38 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.54 Median $0.54 Typical High $0.55 | Professional | 53 · Discontinued | $0.54 | $0.54 | $0.55 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.40 Median $0.40 Typical High $0.41 | Professional | 55 · Aftercare only | $0.40 | $0.40 | $0.41 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.27 Median $0.27 Typical High $0.28 | Professional | 56 · Pre-op care only | $0.27 | $0.27 | $0.28 |
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· 21st of 51
$2.95
AK $3.98NC $2.69
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.