How much rates vary
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 $0.32 Median $0.33 Typical High $0.71 | Facility | None | $0.32 | $0.33 | $0.71 |
Aetna Setting Professional Modifier None Typical Low $0.32 Median $0.33 Typical High $0.33 | Professional | None | $0.32 | $0.33 | $0.33 |
BCBS Texas Setting Facility Modifier None Typical Low $0.91 Median $2.09 Typical High $3.72 | Facility | None | $0.91 | $2.09 | $3.72 |
BCBS Texas Setting Professional Modifier None Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | None | $0.28 | $0.28 | $0.28 |
Cigna Setting Facility Modifier None Typical Low $0.32 Median $0.76 Typical High $1.02 | Facility | None | $0.32 | $0.76 | $1.02 |
Cigna Setting Professional Modifier None Typical Low $0.32 Median $0.32 Typical High $0.32 | Professional | None | $0.32 | $0.32 | $0.32 |
Moda Health Setting Facility Modifier None Typical Low $0.28 Median $0.39 Typical High $1.17 | Facility | None | $0.28 | $0.39 | $1.17 |
Moda Health Setting Professional Modifier None Typical Low $0.28 Median $0.29 Typical High $0.33 | Professional | None | $0.28 | $0.29 | $0.33 |
Molina Setting Professional Modifier None Typical Low $0.28 Median $0.29 Typical High $0.33 | Professional | None | $0.28 | $0.29 | $0.33 |
Providence Setting Facility Modifier None Typical Low $0.31 Median $0.46 Typical High $2.75 | Facility | None | $0.31 | $0.46 | $2.75 |
Providence Setting Professional Modifier None Typical Low $0.32 Median $0.32 Typical High $0.32 | Professional | None | $0.32 | $0.32 | $0.32 |
United Setting Facility Modifier None Typical Low $0.32 Median $0.32 Typical High $0.32 | Facility | None | $0.32 | $0.32 | $0.32 |
United Setting Professional Modifier None Typical Low $0.28 Median $0.30 Typical High $0.31 | Professional | None | $0.28 | $0.30 | $0.31 |
Wellpoint Setting Professional Modifier None Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | None | $0.28 | $0.28 | $0.28 |
8 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 Professional Modifier 52 · Reduced service Typical Low $0.16 Median $0.17 Typical High $0.17 | Professional | 52 · Reduced service | $0.16 | $0.17 | $0.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.06 Median $0.07 Typical High $0.07 | Professional | 53 · Discontinued | $0.06 | $0.07 | $0.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.05 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.05 | $0.05 | $0.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | 56 · Pre-op care only | $0.03 | $0.03 | $0.03 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $0.14 Median $0.15 Typical High $0.15 | Professional | 52 · Reduced service | $0.14 | $0.15 | $0.15 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $0.06 Median $0.06 Typical High $0.06 | Professional | 53 · Discontinued | $0.06 | $0.06 | $0.06 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $0.04 Median $0.04 Typical High $0.04 | Professional | 55 · Aftercare only | $0.04 | $0.04 | $0.04 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | 56 · Pre-op care only | $0.03 | $0.03 | $0.03 |
Where Texas sits
The same service costs 2.8 times more in Texas than in Rhode Island. 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· 1st of 51
$0.78
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.