How much rates vary
Facilitymedian $98 · 10th to 90th $66 to $234Professionalmedian $93 · 10th to 90th $66 to $141
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 $66.07 Median $93.33 Typical High $162.18 | Facility | None | $66.07 | $93.33 | $162.18 |
Aetna Setting Facility Modifier 52 · Reduced service Typical Low $32.36 Median $38.90 Typical High $45.71 | Facility | 52 · Reduced service | $32.36 | $38.90 | $45.71 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $9.77 Median $11.75 Typical High $13.80 | Facility | 55 · Aftercare only | $9.77 | $11.75 | $13.80 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $6.46 Median $7.76 Typical High $9.33 | Facility | 56 · Pre-op care only | $6.46 | $7.76 | $9.33 |
Aetna Setting Professional Modifier None Typical Low $64.57 Median $91.20 Typical High $120.23 | Professional | None | $64.57 | $91.20 | $120.23 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $32.36 Median $40.74 Typical High $43.65 | Professional | 52 · Reduced service | $32.36 | $40.74 | $43.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $12.02 Typical High $13.18 | Professional | 55 · Aftercare only | $9.77 | $12.02 | $13.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.46 Median $7.94 Typical High $8.71 | Professional | 56 · Pre-op care only | $6.46 | $7.94 | $8.71 |
Ambetter Setting Professional Modifier None Typical Low $87.10 Median $123.03 Typical High $177.83 | Professional | None | $87.10 | $123.03 | $177.83 |
AmeriHealth Setting Facility Modifier None Typical Low $85.11 Median $85.11 Typical High $85.11 | Facility | None | $85.11 | $85.11 | $85.11 |
AmeriHealth Setting Professional Modifier None Typical Low $87.10 Median $107.15 Typical High $125.89 | Professional | None | $87.10 | $107.15 | $125.89 |
Capital Blue Cross Setting Facility Modifier None Typical Low $4,265.80 Median $5,011.87 Typical High $79,432.82 | Facility | None | $4,265.80 | $5,011.87 | $79,432.82 |
Capital Blue Cross Setting Professional Modifier None Typical Low $120.23 Median $177.83 Typical High $223.87 | Professional | None | $120.23 | $177.83 | $223.87 |
Cigna Setting Facility Modifier None Typical Low $109.65 Median $147.91 Typical High $257.04 | Facility | None | $109.65 | $147.91 | $257.04 |
Cigna Setting Professional Modifier None Typical Low $66.07 Median $91.20 Typical High $128.82 | Professional | None | $66.07 | $91.20 | $128.82 |
Emblem Health Setting Facility Modifier None Typical Low $50.12 Median $50.12 Typical High $50.12 | Facility | None | $50.12 | $50.12 | $50.12 |
Emblem Health Setting Professional Modifier None Typical Low $44.67 Median $67.61 Typical High $199.53 | Professional | None | $44.67 | $67.61 | $199.53 |
Geisinger Setting Facility Modifier None Typical Low $87.10 Median $87.10 Typical High $104.71 | Facility | None | $87.10 | $87.10 | $104.71 |
Geisinger Setting Professional Modifier None Typical Low $87.10 Median $120.23 Typical High $208.93 | Professional | None | $87.10 | $120.23 | $208.93 |
Highmark BCBS Setting Facility Modifier None Typical Low $72.44 Median $218.78 Typical High $331.13 | Facility | None | $72.44 | $218.78 | $331.13 |
Highmark BCBS Setting Professional Modifier None Typical Low $83.18 Median $123.03 Typical High $190.55 | Professional | None | $83.18 | $123.03 | $190.55 |
Independence Blue Cross Setting Facility Modifier None Typical Low $114.82 Median $1,148.15 Typical High $3,467.37 | Facility | None | $114.82 | $1,148.15 | $3,467.37 |
Independence Blue Cross Setting Professional Modifier None Typical Low $87.10 Median $107.15 Typical High $125.89 | Professional | None | $87.10 | $107.15 | $125.89 |
Martin's Point Setting Facility Modifier None Typical Low $66.07 Median $93.33 Typical High $165.96 | Facility | None | $66.07 | $93.33 | $165.96 |
Martin's Point Setting Facility Modifier 52 · Reduced service Typical Low $32.36 Median $38.90 Typical High $45.71 | Facility | 52 · Reduced service | $32.36 | $38.90 | $45.71 |
Martin's Point Setting Facility Modifier 55 · Aftercare only Typical Low $9.77 Median $11.75 Typical High $13.80 | Facility | 55 · Aftercare only | $9.77 | $11.75 | $13.80 |
Martin's Point Setting Facility Modifier 56 · Pre-op care only Typical Low $6.46 Median $7.76 Typical High $9.33 | Facility | 56 · Pre-op care only | $6.46 | $7.76 | $9.33 |
Martin's Point Setting Professional Modifier None Typical Low $64.57 Median $91.20 Typical High $120.23 | Professional | None | $64.57 | $91.20 | $120.23 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $32.36 Median $40.74 Typical High $43.65 | Professional | 52 · Reduced service | $32.36 | $40.74 | $43.65 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $12.02 Typical High $13.18 | Professional | 55 · Aftercare only | $9.77 | $12.02 | $13.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.46 Median $7.76 Typical High $8.71 | Professional | 56 · Pre-op care only | $6.46 | $7.76 | $8.71 |
Optum Setting Professional Modifier None Typical Low $100.00 Median $112.20 Typical High $120.23 | Professional | None | $100.00 | $112.20 | $120.23 |
Oscar Health Setting Professional Modifier None Typical Low $63.10 Median $112.20 Typical High $165.96 | Professional | None | $63.10 | $112.20 | $165.96 |
UPMC Health Plan Setting Facility Modifier None Typical Low $81.28 Median $109.65 Typical High $288.40 | Facility | None | $81.28 | $109.65 | $288.40 |
UPMC Health Plan Setting Professional Modifier None Typical Low $81.28 Median $100.00 Typical High $109.65 | Professional | None | $81.28 | $100.00 | $109.65 |
United Setting Professional Modifier None Typical Low $64.57 Median $89.13 Typical High $125.89 | Professional | None | $64.57 | $89.13 | $125.89 |
11 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 AF · Specialist physician Typical Low $72.44 Median $120.23 Typical High $208.93 | Professional | AF · Specialist physician | $72.44 | $120.23 | $208.93 |
Aetna Setting Professional Modifier HO · Master's level Typical Low $53.70 Median $91.20 Typical High $158.49 | Professional | HO · Master's level | $53.70 | $91.20 | $158.49 |
Aetna Setting Professional Modifier TD · Registered nurse Typical Low $61.66 Median $102.33 Typical High $177.83 | Professional | TD · Registered nurse | $61.66 | $102.33 | $177.83 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $95.50 Median $114.82 Typical High $177.83 | Professional | 25 · Same-day visit | $95.50 | $114.82 | $177.83 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $112.20 Median $141.25 Typical High $199.53 | Professional | GC · Resident with teaching physician | $112.20 | $141.25 | $199.53 |
Ambetter Setting Professional Modifier GE · Resident, primary care exception Typical Low $107.15 Median $162.18 Typical High $177.83 | Professional | GE · Resident, primary care exception | $107.15 | $162.18 | $177.83 |
Highmark BCBS Setting Professional Modifier 25 · Same-day visit Typical Low $89.13 Median $117.49 Typical High $177.83 | Professional | 25 · Same-day visit | $89.13 | $117.49 | $177.83 |
Highmark BCBS Setting Professional Modifier GC · Resident with teaching physician Typical Low $85.11 Median $117.49 Typical High $173.78 | Professional | GC · Resident with teaching physician | $85.11 | $117.49 | $173.78 |
Martin's Point Setting Professional Modifier AF · Specialist physician Typical Low $72.44 Median $120.23 Typical High $208.93 | Professional | AF · Specialist physician | $72.44 | $120.23 | $208.93 |
Martin's Point Setting Professional Modifier HO · Master's level Typical Low $53.70 Median $91.20 Typical High $158.49 | Professional | HO · Master's level | $53.70 | $91.20 | $158.49 |
Martin's Point Setting Professional Modifier TD · Registered nurse Typical Low $61.66 Median $102.33 Typical High $177.83 | Professional | TD · Registered nurse | $61.66 | $102.33 | $177.83 |
Where Pennsylvania sits
The same service costs 2.3 times more in Alaska than in Alabama. 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.
Pennsylvania· 35th of 51
$93.33
AK $170AL $74.13
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.