How much rates vary
Facilitymedian $2 · 10th to 90th $0 to $5,012Professionalmedian $0 · 10th to 90th $0 to $0
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 $0.21 Median $0.21 Typical High $0.23 | Facility | None | $0.21 | $0.21 | $0.23 |
Aetna Setting Professional Modifier None Typical Low $0.21 Median $0.23 Typical High $0.23 | Professional | None | $0.21 | $0.23 | $0.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | 55 · Aftercare only | $0.03 | $0.03 | $0.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.02 Median $0.02 Typical High $0.02 | Professional | 56 · Pre-op care only | $0.02 | $0.02 | $0.02 |
Aetna Setting Professional Modifier AW · With surgical dressing Typical Low $0.15 Median $0.15 Typical High $0.15 | Professional | AW · With surgical dressing | $0.15 | $0.15 | $0.15 |
Ambetter Setting Professional Modifier None Typical Low $23.99 Median $23.99 Typical High $23.99 | Professional | None | $23.99 | $23.99 | $23.99 |
Ambetter Setting Professional Modifier AW · With surgical dressing Typical Low $40.74 Median $40.74 Typical High $40.74 | Professional | AW · With surgical dressing | $40.74 | $40.74 | $40.74 |
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 $0.44 Median $0.49 Typical High $0.49 | Professional | None | $0.44 | $0.49 | $0.49 |
Capital Blue Cross Setting Professional Modifier AW · With surgical dressing Typical Low $0.48 Median $0.52 Typical High $0.52 | Professional | AW · With surgical dressing | $0.48 | $0.52 | $0.52 |
Cigna Setting Facility Modifier None Typical Low $0.30 Median $0.30 Typical High $0.30 | Facility | None | $0.30 | $0.30 | $0.30 |
Cigna Setting Professional Modifier None Typical Low $0.26 Median $0.26 Typical High $0.26 | Professional | None | $0.26 | $0.26 | $0.26 |
Emblem Health Setting Professional Modifier None Typical Low $0.66 Median $0.72 Typical High $0.93 | Professional | None | $0.66 | $0.72 | $0.93 |
Geisinger Setting Facility Modifier AW · With surgical dressing Typical Low $0.54 Median $0.54 Typical High $0.54 | Facility | AW · With surgical dressing | $0.54 | $0.54 | $0.54 |
Geisinger Setting Professional Modifier None Typical Low $0.29 Median $0.29 Typical High $0.44 | Professional | None | $0.29 | $0.29 | $0.44 |
Geisinger Setting Professional Modifier AW · With surgical dressing Typical Low $0.32 Median $0.32 Typical High $0.54 | Professional | AW · With surgical dressing | $0.32 | $0.32 | $0.54 |
Highmark BCBS Setting Professional Modifier None Typical Low $0.35 Median $0.35 Typical High $0.35 | Professional | None | $0.35 | $0.35 | $0.35 |
Martin's Point Setting Facility Modifier None Typical Low $0.21 Median $0.21 Typical High $0.21 | Facility | None | $0.21 | $0.21 | $0.21 |
Martin's Point Setting Professional Modifier None Typical Low $0.21 Median $0.23 Typical High $0.23 | Professional | None | $0.21 | $0.23 | $0.23 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | 55 · Aftercare only | $0.03 | $0.03 | $0.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.02 Median $0.02 Typical High $0.02 | Professional | 56 · Pre-op care only | $0.02 | $0.02 | $0.02 |
Martin's Point Setting Professional Modifier AW · With surgical dressing Typical Low $0.15 Median $0.15 Typical High $0.15 | Professional | AW · With surgical dressing | $0.15 | $0.15 | $0.15 |
Oscar Health Setting Professional Modifier None Typical Low $0.40 Median $0.79 Typical High $0.79 | Professional | None | $0.40 | $0.79 | $0.79 |
UPMC Health Plan Setting Facility Modifier None Typical Low $0.37 Median $1.82 Typical High $2.88 | Facility | None | $0.37 | $1.82 | $2.88 |
UPMC Health Plan Setting Professional Modifier None Typical Low $0.37 Median $0.37 Typical High $0.37 | Professional | None | $0.37 | $0.37 | $0.37 |
UPMC Health Plan Setting Professional Modifier AW · With surgical dressing Typical Low $0.40 Median $0.40 Typical High $0.51 | Professional | AW · With surgical dressing | $0.40 | $0.40 | $0.51 |
United Setting Professional Modifier None Typical Low $0.23 Median $0.27 Typical High $0.40 | Professional | None | $0.23 | $0.27 | $0.40 |
2 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 |
|---|---|---|---|---|---|
Geisinger Setting Professional Modifier AU · Urologic/ostomy supply Typical Low $0.30 Median $0.30 Typical High $0.50 | Professional | AU · Urologic/ostomy supply | $0.30 | $0.30 | $0.50 |
Geisinger Setting Professional Modifier AV · With prosthetic/orthotic Typical Low $0.30 Median $0.30 Typical High $0.50 | Professional | AV · With prosthetic/orthotic | $0.30 | $0.30 | $0.50 |
Where Pennsylvania sits
The same service costs 2.5 times more in Montana than in Colorado. 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· 36th of 51
$0.26
MT $0.56CO $0.23
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.