How much rates vary
Facilitymedian $66 · 10th to 90th $58 to $151Professionalmedian $58 · 10th to 90th $52 to $59
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 $57.54 Median $75.86 Typical High $144.54 | Facility | None | $57.54 | $75.86 | $144.54 |
Aetna Setting Professional Modifier None Typical Low $57.54 Median $57.54 Typical High $58.88 | Professional | None | $57.54 | $57.54 | $58.88 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $28.84 Median $28.84 Typical High $28.84 | Professional | 52 · Reduced service | $28.84 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $11.48 Typical High $11.48 | Professional | 53 · Discontinued | $11.48 | $11.48 | $11.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $8.51 Typical High $8.71 | Professional | 55 · Aftercare only | $8.51 | $8.51 | $8.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $5.75 Typical High $5.75 | Professional | 56 · Pre-op care only | $5.75 | $5.75 | $5.75 |
Ambetter Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $57.54 | Professional | None | $54.95 | $54.95 | $57.54 |
Capital Blue Cross Setting Facility Modifier None Typical Low $53.70 Median $61.66 Typical High $74.13 | Facility | None | $53.70 | $61.66 | $74.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $53.70 Median $58.88 Typical High $58.88 | Professional | None | $53.70 | $58.88 | $58.88 |
Cigna Setting Facility Modifier None Typical Low $57.54 Median $95.50 Typical High $218.78 | Facility | None | $57.54 | $95.50 | $218.78 |
Cigna Setting Professional Modifier None Typical Low $57.54 Median $57.54 Typical High $57.54 | Professional | None | $57.54 | $57.54 | $57.54 |
Emblem Health Setting Professional Modifier None Typical Low $58.88 Median $61.66 Typical High $83.18 | Professional | None | $58.88 | $61.66 | $83.18 |
Geisinger Setting Facility Modifier None Typical Low $57.54 Median $57.54 Typical High $57.54 | Facility | None | $57.54 | $57.54 | $57.54 |
Geisinger Setting Professional Modifier None Typical Low $43.65 Median $60.26 Typical High $97.72 | Professional | None | $43.65 | $60.26 | $97.72 |
Highmark BCBS Setting Facility Modifier None Typical Low $43.65 Median $147.91 Typical High $169.82 | Facility | None | $43.65 | $147.91 | $169.82 |
Highmark BCBS Setting Professional Modifier None Typical Low $60.26 Median $61.66 Typical High $61.66 | Professional | None | $60.26 | $61.66 | $61.66 |
Martin's Point Setting Facility Modifier None Typical Low $57.54 Median $75.86 Typical High $144.54 | Facility | None | $57.54 | $75.86 | $144.54 |
Martin's Point Setting Professional Modifier None Typical Low $57.54 Median $57.54 Typical High $57.54 | Professional | None | $57.54 | $57.54 | $57.54 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $28.84 Median $28.84 Typical High $28.84 | Professional | 52 · Reduced service | $28.84 | $28.84 | $28.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $11.48 Typical High $11.48 | Professional | 53 · Discontinued | $11.48 | $11.48 | $11.48 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $8.51 Typical High $8.71 | Professional | 55 · Aftercare only | $8.51 | $8.51 | $8.71 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $5.75 Typical High $5.75 | Professional | 56 · Pre-op care only | $5.75 | $5.75 | $5.75 |
Oscar Health Setting Professional Modifier None Typical Low $0.60 Median $30.20 Typical High $102.33 | Professional | None | $0.60 | $30.20 | $102.33 |
UPMC Health Plan Setting Facility Modifier None Typical Low $46.77 Median $66.07 Typical High $69.18 | Facility | None | $46.77 | $66.07 | $69.18 |
UPMC Health Plan Setting Professional Modifier None Typical Low $46.77 Median $47.86 Typical High $53.70 | Professional | None | $46.77 | $47.86 | $53.70 |
United Setting Facility Modifier None Typical Low $57.54 Median $57.54 Typical High $57.54 | Facility | None | $57.54 | $57.54 | $57.54 |
United Setting Professional Modifier None Typical Low $51.29 Median $57.54 Typical High $61.66 | Professional | None | $51.29 | $57.54 | $61.66 |
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 |
|---|---|---|---|---|---|
Highmark BCBS Setting Facility Modifier JZ · No drug discarded Typical Low $53.70 Median $147.91 Typical High $208.93 | Facility | JZ · No drug discarded | $53.70 | $147.91 | $208.93 |
Highmark BCBS Setting Professional Modifier JZ · No drug discarded Typical Low $57.54 Median $61.66 Typical High $63.10 | Professional | JZ · No drug discarded | $57.54 | $61.66 | $63.10 |
Where Pennsylvania sits
Rates are fairly even across states for this service. 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· 45th of 51
$57.54
AK $70.79NJ $57.54
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.