How much rates vary
Facilitymedian $2 · 10th to 90th $0 to $5,012Professionalmedian $0 · 10th to 90th $0 to $1
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 $0.27 Median $0.27 Typical High $1,548.82 | Facility | None | $0.27 | $0.27 | $1,548.82 |
Aetna Setting Professional Modifier None Typical Low $0.27 Median $0.34 Typical High $0.34 | Professional | None | $0.27 | $0.34 | $0.34 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.14 Median $0.17 Typical High $0.17 | Professional | 52 · Reduced service | $0.14 | $0.17 | $0.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.05 Median $0.07 Typical High $0.07 | Professional | 53 · Discontinued | $0.05 | $0.07 | $0.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.04 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.04 | $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 |
Ambetter Setting Professional Modifier None Typical Low $40.74 Median $40.74 Typical High $40.74 | Professional | None | $40.74 | $40.74 | $40.74 |
AmeriHealth Setting Professional Modifier None Typical Low $0.35 Median $0.35 Typical High $0.35 | Professional | None | $0.35 | $0.35 | $0.35 |
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 $0.49 Median $0.54 Typical High $0.54 | Professional | None | $0.49 | $0.54 | $0.54 |
Cigna Setting Facility Modifier None Typical Low $0.33 Median $0.33 Typical High $0.33 | Facility | None | $0.33 | $0.33 | $0.33 |
Cigna Setting Professional Modifier None Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | None | $0.28 | $0.28 | $0.28 |
Emblem Health Setting Professional Modifier None Typical Low $0.72 Median $0.79 Typical High $1.00 | Professional | None | $0.72 | $0.79 | $1.00 |
Geisinger Setting Facility Modifier None Typical Low $0.55 Median $0.55 Typical High $0.55 | Facility | None | $0.55 | $0.55 | $0.55 |
Geisinger Setting Professional Modifier None Typical Low $0.33 Median $0.36 Typical High $0.55 | Professional | None | $0.33 | $0.36 | $0.55 |
Martin's Point Setting Facility Modifier None Typical Low $0.27 Median $0.27 Typical High $1,548.82 | Facility | None | $0.27 | $0.27 | $1,548.82 |
Martin's Point Setting Professional Modifier None Typical Low $0.27 Median $0.34 Typical High $0.34 | Professional | None | $0.27 | $0.34 | $0.34 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $0.14 Median $0.17 Typical High $0.17 | Professional | 52 · Reduced service | $0.14 | $0.17 | $0.17 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.05 Median $0.07 Typical High $0.07 | Professional | 53 · Discontinued | $0.05 | $0.07 | $0.07 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.04 Median $0.05 Typical High $0.05 | Professional | 55 · Aftercare only | $0.04 | $0.05 | $0.05 |
Martin's Point 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 |
Oscar Health Setting Professional Modifier None Typical Low $0.60 Median $0.79 Typical High $0.79 | Professional | None | $0.60 | $0.79 | $0.79 |
UPMC Health Plan Setting Facility Modifier None Typical Low $0.41 Median $1.86 Typical High $3.24 | Facility | None | $0.41 | $1.86 | $3.24 |
UPMC Health Plan Setting Professional Modifier None Typical Low $0.41 Median $0.41 Typical High $0.52 | Professional | None | $0.41 | $0.41 | $0.52 |
United Setting Professional Modifier None Typical Low $0.23 Median $0.28 Typical High $0.41 | Professional | None | $0.23 | $0.28 | $0.41 |
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 |
|---|---|---|---|---|---|
Ambetter Setting Professional Modifier A1 · Dressing, 1 wound Typical Low $40.74 Median $53.70 Typical High $53.70 | Professional | A1 · Dressing, 1 wound | $40.74 | $53.70 | $53.70 |
Highmark BCBS Setting Professional Modifier A1 · Dressing, 1 wound Typical Low $0.41 Median $0.41 Typical High $0.41 | Professional | A1 · Dressing, 1 wound | $0.41 | $0.41 | $0.41 |
Where Pennsylvania sits
The same service costs 2.6 times more in Hawaii than in Utah. 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· 26th of 51
$0.34
HI $0.59UT $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.