How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $0.03 Median $0.03 Typical High $0.05 | Facility | None | $0.03 | $0.03 | $0.05 |
Aetna Setting Professional Modifier None Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | None | $0.03 | $0.03 | $0.03 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.02 Median $0.02 Typical High $0.02 | Professional | 52 · Reduced service | $0.02 | $0.02 | $0.02 |
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 $1.17 Median $1.26 Typical High $1.29 | Professional | None | $1.17 | $1.26 | $1.29 |
Cigna Setting Professional Modifier None Typical Low $0.31 Median $0.31 Typical High $0.31 | Professional | None | $0.31 | $0.31 | $0.31 |
Emblem Health Setting Professional Modifier None Typical Low $7.08 Median $7.08 Typical High $7.08 | Professional | None | $7.08 | $7.08 | $7.08 |
Highmark BCBS Setting Facility Modifier None Typical Low $47.86 Median $47.86 Typical High $47.86 | Facility | None | $47.86 | $47.86 | $47.86 |
Martin's Point Setting Facility Modifier None Typical Low $0.03 Median $0.03 Typical High $0.05 | Facility | None | $0.03 | $0.03 | $0.05 |
Martin's Point Setting Professional Modifier None Typical Low $0.03 Median $0.03 Typical High $0.03 | Professional | None | $0.03 | $0.03 | $0.03 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $0.02 Median $0.02 Typical High $0.02 | Professional | 52 · Reduced service | $0.02 | $0.02 | $0.02 |
Oscar Health Setting Professional Modifier None Typical Low $0.60 Median $0.60 Typical High $0.60 | Professional | None | $0.60 | $0.60 | $0.60 |
6 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 53 · Discontinued Typical Low $0.20 Median $0.20 Typical High $0.79 | Professional | 53 · Discontinued | $0.20 | $0.20 | $0.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.15 Median $0.15 Typical High $0.60 | Professional | 55 · Aftercare only | $0.15 | $0.15 | $0.60 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.10 Median $0.10 Typical High $0.40 | Professional | 56 · Pre-op care only | $0.10 | $0.10 | $0.40 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.20 Median $0.20 Typical High $0.79 | Professional | 53 · Discontinued | $0.20 | $0.20 | $0.79 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.15 Median $0.15 Typical High $0.60 | Professional | 55 · Aftercare only | $0.15 | $0.15 | $0.60 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.10 Median $0.10 Typical High $0.40 | Professional | 56 · Pre-op care only | $0.10 | $0.10 | $0.40 |
Where Pennsylvania sits
The same service costs 2630.3 times more in Montana than in Nevada. 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· 13th of 51
$1.26
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.