How much rates vary
Facilitymedian $20 · 10th to 90th $17 to $45Professionalmedian $17 · 10th to 90th $16 to $18
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 $17.38 Median $23.99 Typical High $44.67 | Facility | None | $17.38 | $23.99 | $44.67 |
Aetna Setting Professional Modifier None Typical Low $17.38 Median $17.38 Typical High $17.78 | Professional | None | $17.38 | $17.38 | $17.78 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $8.51 Median $8.51 Typical High $8.71 | Professional | 52 · Reduced service | $8.51 | $8.51 | $8.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.47 Median $3.47 Typical High $3.47 | Professional | 53 · Discontinued | $3.47 | $3.47 | $3.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.57 Median $2.57 Typical High $2.63 | Professional | 55 · Aftercare only | $2.57 | $2.57 | $2.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.74 Median $1.74 Typical High $1.74 | Professional | 56 · Pre-op care only | $1.74 | $1.74 | $1.74 |
Capital Blue Cross Setting Facility Modifier None Typical Low $16.22 Median $18.62 Typical High $22.39 | Facility | None | $16.22 | $18.62 | $22.39 |
Capital Blue Cross Setting Professional Modifier None Typical Low $16.22 Median $17.78 Typical High $17.78 | Professional | None | $16.22 | $17.78 | $17.78 |
Cigna Setting Facility Modifier None Typical Low $17.38 Median $28.84 Typical High $66.07 | Facility | None | $17.38 | $28.84 | $66.07 |
Cigna Setting Professional Modifier None Typical Low $17.38 Median $17.38 Typical High $17.38 | Professional | None | $17.38 | $17.38 | $17.38 |
Emblem Health Setting Professional Modifier None Typical Low $17.38 Median $17.38 Typical High $25.12 | Professional | None | $17.38 | $17.38 | $25.12 |
Geisinger Setting Facility Modifier None Typical Low $17.38 Median $17.38 Typical High $17.38 | Facility | None | $17.38 | $17.38 | $17.38 |
Geisinger Setting Professional Modifier None Typical Low $10.23 Median $17.78 Typical High $28.84 | Professional | None | $10.23 | $17.78 | $28.84 |
Highmark BCBS Setting Facility Modifier None Typical Low $13.18 Median $30.20 Typical High $52.48 | Facility | None | $13.18 | $30.20 | $52.48 |
Highmark BCBS Setting Professional Modifier None Typical Low $18.20 Median $18.20 Typical High $18.20 | Professional | None | $18.20 | $18.20 | $18.20 |
Martin's Point Setting Facility Modifier None Typical Low $17.38 Median $24.55 Typical High $44.67 | Facility | None | $17.38 | $24.55 | $44.67 |
Martin's Point Setting Professional Modifier None Typical Low $17.38 Median $17.38 Typical High $17.38 | Professional | None | $17.38 | $17.38 | $17.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $8.51 Median $8.51 Typical High $8.71 | Professional | 52 · Reduced service | $8.51 | $8.51 | $8.71 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $3.47 Median $3.47 Typical High $3.47 | Professional | 53 · Discontinued | $3.47 | $3.47 | $3.47 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.57 Median $2.57 Typical High $2.63 | Professional | 55 · Aftercare only | $2.57 | $2.57 | $2.63 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.74 Median $1.74 Typical High $1.74 | Professional | 56 · Pre-op care only | $1.74 | $1.74 | $1.74 |
Oscar Health Setting Professional Modifier None Typical Low $14.45 Median $16.98 Typical High $30.20 | Professional | None | $14.45 | $16.98 | $30.20 |
UPMC Health Plan Setting Facility Modifier None Typical Low $14.45 Median $19.95 Typical High $20.89 | Facility | None | $14.45 | $19.95 | $20.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $14.45 Median $14.79 Typical High $16.60 | Professional | None | $14.45 | $14.79 | $16.60 |
United Setting Facility Modifier None Typical Low $17.38 Median $17.38 Typical High $17.38 | Facility | None | $17.38 | $17.38 | $17.38 |
United Setting Professional Modifier None Typical Low $15.85 Median $18.20 Typical High $19.05 | Professional | None | $15.85 | $18.20 | $19.05 |
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 JZ · No drug discarded Typical Low $17.38 Median $17.38 Typical High $17.78 | Professional | JZ · No drug discarded | $17.38 | $17.38 | $17.78 |
Highmark BCBS Setting Facility Modifier JZ · No drug discarded Typical Low $14.45 Median $44.67 Typical High $69.18 | Facility | JZ · No drug discarded | $14.45 | $44.67 | $69.18 |
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· 43rd of 51
$17.38
AK $21.88NC $16.98
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.