How much rates vary
Facilitymedian $123 · 10th to 90th $78 to $4,786Professionalmedian $112 · 10th to 90th $78 to $191
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 $77.62 Median $81.28 Typical High $123.03 | Facility | None | $77.62 | $81.28 | $123.03 |
Aetna Setting Professional Modifier None Typical Low $77.62 Median $104.71 Typical High $158.49 | Professional | None | $77.62 | $104.71 | $158.49 |
Ambetter Setting Professional Modifier None Typical Low $75.86 Median $77.62 Typical High $134.90 | Professional | None | $75.86 | $77.62 | $134.90 |
AmeriHealth Setting Facility Modifier None Typical Low $173.78 Median $323.59 Typical High $5,370.32 | Facility | None | $173.78 | $323.59 | $5,370.32 |
AmeriHealth Setting Professional Modifier None Typical Low $97.72 Median $104.71 Typical High $123.03 | Professional | None | $97.72 | $104.71 | $123.03 |
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 $89.13 Median $165.96 Typical High $199.53 | Professional | None | $89.13 | $165.96 | $199.53 |
Cigna Setting Professional Modifier None Typical Low $77.62 Median $100.00 Typical High $158.49 | Professional | None | $77.62 | $100.00 | $158.49 |
Emblem Health Setting Facility Modifier None Typical Low $54.95 Median $54.95 Typical High $54.95 | Facility | None | $54.95 | $54.95 | $54.95 |
Emblem Health Setting Professional Modifier None Typical Low $66.07 Median $109.65 Typical High $158.49 | Professional | None | $66.07 | $109.65 | $158.49 |
Geisinger Setting Facility Modifier None Typical Low $83.18 Median $83.18 Typical High $100.00 | Facility | None | $83.18 | $83.18 | $100.00 |
Geisinger Setting Professional Modifier None Typical Low $74.13 Median $102.33 Typical High $181.97 | Professional | None | $74.13 | $102.33 | $181.97 |
Highmark BCBS Setting Facility Modifier None Typical Low $95.50 Median $95.50 Typical High $95.50 | Facility | None | $95.50 | $95.50 | $95.50 |
Highmark BCBS Setting Professional Modifier None Typical Low $74.13 Median $87.10 Typical High $186.21 | Professional | None | $74.13 | $87.10 | $186.21 |
Independence Blue Cross Setting Facility Modifier None Typical Low $218.78 Median $338.84 Typical High $8,128.31 | Facility | None | $218.78 | $338.84 | $8,128.31 |
Independence Blue Cross Setting Professional Modifier None Typical Low $89.13 Median $104.71 Typical High $131.83 | Professional | None | $89.13 | $104.71 | $131.83 |
Martin's Point Setting Facility Modifier None Typical Low $77.62 Median $79.43 Typical High $123.03 | Facility | None | $77.62 | $79.43 | $123.03 |
Martin's Point Setting Professional Modifier None Typical Low $77.62 Median $104.71 Typical High $158.49 | Professional | None | $77.62 | $104.71 | $158.49 |
Optum Setting Professional Modifier None Typical Low $50.12 Median $83.18 Typical High $114.82 | Professional | None | $50.12 | $83.18 | $114.82 |
Oscar Health Setting Professional Modifier None Typical Low $74.13 Median $83.18 Typical High $190.55 | Professional | None | $74.13 | $83.18 | $190.55 |
UPMC Health Plan Setting Facility Modifier None Typical Low $81.28 Median $138.04 Typical High $204.17 | Facility | None | $81.28 | $138.04 | $204.17 |
UPMC Health Plan Setting Professional Modifier None Typical Low $81.28 Median $102.33 Typical High $102.33 | Professional | None | $81.28 | $102.33 | $102.33 |
United Setting Professional Modifier None Typical Low $79.43 Median $102.33 Typical High $190.55 | Professional | None | $79.43 | $102.33 | $190.55 |
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 $38.90 Median $38.90 Typical High $43.65 | Facility | 52 · Reduced service | $38.90 | $38.90 | $43.65 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $11.48 Median $11.75 Typical High $13.18 | Facility | 55 · Aftercare only | $11.48 | $11.75 | $13.18 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $7.76 Median $7.94 Typical High $8.71 | Facility | 56 · Pre-op care only | $7.76 | $7.94 | $8.71 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $38.02 Median $38.90 Typical High $39.81 | Professional | 52 · Reduced service | $38.02 | $38.90 | $39.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $11.75 Typical High $12.02 | Professional | 55 · Aftercare only | $11.48 | $11.75 | $12.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $7.94 Typical High $7.94 | Professional | 56 · Pre-op care only | $7.59 | $7.94 | $7.94 |
Ambetter Setting Professional Modifier 25 · Same-day visit Typical Low $74.13 Median $74.13 Typical High $95.50 | Professional | 25 · Same-day visit | $74.13 | $74.13 | $95.50 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $107.15 Median $117.49 Typical High $144.54 | Professional | GC · Resident with teaching physician | $107.15 | $117.49 | $144.54 |
Martin's Point Setting Facility Modifier 52 · Reduced service Typical Low $38.90 Median $38.90 Typical High $43.65 | Facility | 52 · Reduced service | $38.90 | $38.90 | $43.65 |
Martin's Point Setting Facility Modifier 55 · Aftercare only Typical Low $11.48 Median $11.75 Typical High $13.18 | Facility | 55 · Aftercare only | $11.48 | $11.75 | $13.18 |
Martin's Point Setting Facility Modifier 56 · Pre-op care only Typical Low $7.76 Median $7.94 Typical High $8.71 | Facility | 56 · Pre-op care only | $7.76 | $7.94 | $8.71 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $38.90 Median $38.90 Typical High $38.90 | Professional | 52 · Reduced service | $38.90 | $38.90 | $38.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $11.75 Typical High $11.75 | Professional | 55 · Aftercare only | $11.48 | $11.75 | $11.75 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $7.94 Typical High $7.94 | Professional | 56 · Pre-op care only | $7.76 | $7.94 | $7.94 |
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· 19th of 51
$112
AK $174AL $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.