How much rates vary
Facilitymedian $155 · 10th to 90th $71 to $288Professionalmedian $76 · 10th to 90th $76 to $83
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 $75.86 Median $100.00 Typical High $165.96 | Facility | None | $75.86 | $100.00 | $165.96 |
Aetna Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $79.43 | Professional | None | $75.86 | $75.86 | $79.43 |
Ambetter Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | None | $75.86 | $75.86 | $75.86 |
BCBS Texas Setting Facility Modifier None Typical Low $64.57 Median $162.18 Typical High $302.00 | Facility | None | $64.57 | $162.18 | $302.00 |
BCBS Texas Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | None | $75.86 | $75.86 | $75.86 |
Cigna Setting Facility Modifier None Typical Low $75.86 Median $144.54 Typical High $245.47 | Facility | None | $75.86 | $144.54 | $245.47 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | None | $75.86 | $75.86 | $75.86 |
Lucent Health Setting Professional Modifier None Typical Low $83.18 Median $83.18 Typical High $138.04 | Professional | None | $83.18 | $83.18 | $138.04 |
Moda Health Setting Facility Modifier None Typical Low $75.86 Median $91.20 Typical High $158.49 | Facility | None | $75.86 | $91.20 | $158.49 |
Moda Health Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $77.62 | Professional | None | $75.86 | $75.86 | $77.62 |
Molina Setting Professional Modifier None Typical Low $74.13 Median $74.13 Typical High $85.11 | Professional | None | $74.13 | $74.13 | $85.11 |
Oscar Health Setting Professional Modifier None Typical Low $81.28 Median $134.90 Typical High $281.84 | Professional | None | $81.28 | $134.90 | $281.84 |
Providence Setting Facility Modifier None Typical Low $75.86 Median $109.65 Typical High $660.69 | Facility | None | $75.86 | $109.65 | $660.69 |
Providence Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | None | $75.86 | $75.86 | $75.86 |
United Setting Facility Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Facility | None | $75.86 | $75.86 | $75.86 |
United Setting Professional Modifier None Typical Low $75.86 Median $79.43 Typical High $85.11 | Professional | None | $75.86 | $79.43 | $85.11 |
Wellpoint Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | None | $75.86 | $75.86 | $75.86 |
17 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 $38.02 Median $50.12 Typical High $83.18 | Facility | 52 · Reduced service | $38.02 | $50.12 | $83.18 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $15.14 Median $19.95 Typical High $33.11 | Facility | 53 · Discontinued | $15.14 | $19.95 | $33.11 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $57.54 Median $79.43 Typical High $123.03 | Facility | 54 · Surgery only | $57.54 | $79.43 | $123.03 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $11.48 Median $14.79 Typical High $24.55 | Facility | 55 · Aftercare only | $11.48 | $14.79 | $24.55 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $7.59 Median $10.00 Typical High $16.60 | Facility | 56 · Pre-op care only | $7.59 | $10.00 | $16.60 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $38.02 Median $38.02 Typical High $39.81 | Professional | 52 · Reduced service | $38.02 | $38.02 | $39.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.14 Median $15.14 Typical High $15.85 | Professional | 53 · Discontinued | $15.14 | $15.14 | $15.85 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $57.54 Typical High $58.88 | Professional | 54 · Surgery only | $57.54 | $57.54 | $58.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $11.48 Typical High $11.75 | Professional | 55 · Aftercare only | $11.48 | $11.48 | $11.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $7.59 Typical High $7.94 | Professional | 56 · Pre-op care only | $7.59 | $7.59 | $7.94 |
Ambetter Setting Professional Modifier JW · Drug discarded Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | JW · Drug discarded | $75.86 | $75.86 | $75.86 |
Ambetter Setting Professional Modifier JZ · No drug discarded Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | JZ · No drug discarded | $75.86 | $75.86 | $75.86 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $38.02 Median $38.02 Typical High $38.90 | Professional | 52 · Reduced service | $38.02 | $38.02 | $38.90 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $15.14 Median $15.14 Typical High $15.49 | Professional | 53 · Discontinued | $15.14 | $15.14 | $15.49 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $56.23 Median $56.23 Typical High $58.88 | Professional | 54 · Surgery only | $56.23 | $56.23 | $58.88 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $11.22 Median $11.22 Typical High $11.75 | Professional | 55 · Aftercare only | $11.22 | $11.22 | $11.75 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $7.59 Typical High $7.76 | Professional | 56 · Pre-op care only | $7.59 | $7.59 | $7.76 |
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· 50th of 51
$75.86
AK $93.33NJ $75.86
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.