How much rates vary
Facilitymedian $83 · 10th to 90th $37 to $158Professionalmedian $38 · 10th to 90th $36 to $162
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 $37.15 Median $45.71 Typical High $79.43 | Facility | None | $37.15 | $45.71 | $79.43 |
Aetna Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $38.90 | Professional | None | $38.02 | $38.02 | $38.90 |
Ambetter Setting Professional Modifier None Typical Low $51.29 Median $52.48 Typical High $52.48 | Professional | None | $51.29 | $52.48 | $52.48 |
BCBS Texas Setting Facility Modifier None Typical Low $36.31 Median $89.13 Typical High $165.96 | Facility | None | $36.31 | $89.13 | $165.96 |
BCBS Texas Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $36.31 | Professional | None | $36.31 | $36.31 | $36.31 |
Baylor Scott & White Setting Professional Modifier None Typical Low $36.31 Median $38.02 Typical High $45.71 | Professional | None | $36.31 | $38.02 | $45.71 |
Cigna Setting Facility Modifier None Typical Low $38.02 Median $72.44 Typical High $120.23 | Facility | None | $38.02 | $72.44 | $120.23 |
Cigna Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | None | $38.02 | $38.02 | $38.02 |
Lucent Health Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
Moda Health Setting Facility Modifier None Typical Low $37.15 Median $44.67 Typical High $89.13 | Facility | None | $37.15 | $44.67 | $89.13 |
Moda Health Setting Professional Modifier None Typical Low $37.15 Median $37.15 Typical High $38.02 | Professional | None | $37.15 | $37.15 | $38.02 |
Molina Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $41.69 | Professional | None | $36.31 | $36.31 | $41.69 |
Oscar Health Setting Professional Modifier None Typical Low $39.81 Median $66.07 Typical High $134.90 | Professional | None | $39.81 | $66.07 | $134.90 |
Providence Setting Facility Modifier None Typical Low $38.02 Median $53.70 Typical High $323.59 | Facility | None | $38.02 | $53.70 | $323.59 |
Providence Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | None | $38.02 | $38.02 | $38.02 |
United Setting Facility Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Facility | None | $38.02 | $38.02 | $38.02 |
United Setting Professional Modifier None Typical Low $37.15 Median $38.90 Typical High $41.69 | Professional | None | $37.15 | $38.90 | $41.69 |
Wellpoint Setting Professional Modifier None Typical Low $37.15 Median $37.15 Typical High $37.15 | Professional | None | $37.15 | $37.15 | $37.15 |
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 $18.62 Median $23.99 Typical High $39.81 | Facility | 52 · Reduced service | $18.62 | $23.99 | $39.81 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $7.59 Median $9.55 Typical High $16.22 | Facility | 53 · Discontinued | $7.59 | $9.55 | $16.22 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $5.62 Median $7.24 Typical High $12.02 | Facility | 55 · Aftercare only | $5.62 | $7.24 | $12.02 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $3.80 Median $4.79 Typical High $7.94 | Facility | 56 · Pre-op care only | $3.80 | $4.79 | $7.94 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $18.62 Median $18.62 Typical High $19.50 | Professional | 52 · Reduced service | $18.62 | $18.62 | $19.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.59 Median $7.59 Typical High $7.76 | Professional | 53 · Discontinued | $7.59 | $7.59 | $7.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $5.62 Typical High $5.75 | Professional | 55 · Aftercare only | $5.62 | $5.62 | $5.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.80 Median $3.80 Typical High $3.89 | Professional | 56 · Pre-op care only | $3.80 | $3.80 | $3.89 |
Ambetter Setting Professional Modifier JW · Drug discarded Typical Low $37.15 Median $37.15 Typical High $37.15 | Professional | JW · Drug discarded | $37.15 | $37.15 | $37.15 |
Ambetter Setting Professional Modifier JZ · No drug discarded Typical Low $29.51 Median $38.02 Typical High $38.02 | Professional | JZ · No drug discarded | $29.51 | $38.02 | $38.02 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $18.20 Median $18.20 Typical High $19.05 | Professional | 52 · Reduced service | $18.20 | $18.20 | $19.05 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $7.41 Typical High $7.59 | Professional | 53 · Discontinued | $7.41 | $7.41 | $7.59 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $5.50 Typical High $5.75 | Professional | 55 · Aftercare only | $5.50 | $5.50 | $5.75 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $3.72 Median $3.72 Typical High $3.80 | Professional | 56 · Pre-op care only | $3.72 | $3.72 | $3.80 |
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· 31st of 51
$38.02
AK $47.86HI $37.15
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.