How much rates vary
Facilitymedian $525 · 10th to 90th $58 to $3,981Professionalmedian $59 · 10th to 90th $45 to $107
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 $52.48 Median $588.84 Typical High $6,165.95 | Facility | None | $52.48 | $588.84 | $6,165.95 |
Aetna Setting Professional Modifier None Typical Low $43.65 Median $52.48 Typical High $79.43 | Professional | None | $43.65 | $52.48 | $79.43 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $21.88 Median $26.30 Typical High $27.54 | Professional | 52 · Reduced service | $21.88 | $26.30 | $27.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.71 Median $10.47 Typical High $10.96 | Professional | 53 · Discontinued | $8.71 | $10.47 | $10.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $33.11 Median $38.90 Typical High $40.74 | Professional | 54 · Surgery only | $33.11 | $38.90 | $40.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.61 Median $7.76 Typical High $8.13 | Professional | 55 · Aftercare only | $6.61 | $7.76 | $8.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.37 Median $5.25 Typical High $5.50 | Professional | 56 · Pre-op care only | $4.37 | $5.25 | $5.50 |
AmeriHealth Setting Facility Modifier None Typical Low $1,348.96 Median $1,698.24 Typical High $7,762.47 | Facility | None | $1,348.96 | $1,698.24 | $7,762.47 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $5,011.87 Typical High $56,234.13 | Facility | None | $3,981.07 | $5,011.87 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $60.26 Median $95.50 Typical High $117.49 | Professional | None | $60.26 | $95.50 | $117.49 |
Cigna Setting Facility Modifier None Typical Low $457.09 Median $630.96 Typical High $1,174.90 | Facility | None | $457.09 | $630.96 | $1,174.90 |
Cigna Setting Professional Modifier None Typical Low $48.98 Median $63.10 Typical High $109.65 | Professional | None | $48.98 | $63.10 | $109.65 |
Emblem Health Setting Professional Modifier None Typical Low $95.50 Median $95.50 Typical High $100.00 | Professional | None | $95.50 | $95.50 | $100.00 |
Geisinger Setting Professional Modifier None Typical Low $56.23 Median $69.18 Typical High $114.82 | Professional | None | $56.23 | $69.18 | $114.82 |
Highmark BCBS Setting Facility Modifier None Typical Low $56.23 Median $398.11 Typical High $1,071.52 | Facility | None | $56.23 | $398.11 | $1,071.52 |
Highmark BCBS Setting Professional Modifier None Typical Low $54.95 Median $60.26 Typical High $77.62 | Professional | None | $54.95 | $60.26 | $77.62 |
Independence Blue Cross Setting Facility Modifier None Typical Low $1,148.15 Median $1,698.24 Typical High $7,413.10 | Facility | None | $1,148.15 | $1,698.24 | $7,413.10 |
Martin's Point Setting Facility Modifier None Typical Low $52.48 Median $812.83 Typical High $6,025.60 | Facility | None | $52.48 | $812.83 | $6,025.60 |
Martin's Point Setting Professional Modifier None Typical Low $43.65 Median $52.48 Typical High $85.11 | Professional | None | $43.65 | $52.48 | $85.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $21.88 Median $26.30 Typical High $27.54 | Professional | 52 · Reduced service | $21.88 | $26.30 | $27.54 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $8.71 Median $10.47 Typical High $10.96 | Professional | 53 · Discontinued | $8.71 | $10.47 | $10.96 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $33.11 Median $38.90 Typical High $40.74 | Professional | 54 · Surgery only | $33.11 | $38.90 | $40.74 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $6.61 Median $7.76 Typical High $8.13 | Professional | 55 · Aftercare only | $6.61 | $7.76 | $8.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.37 Median $5.25 Typical High $5.50 | Professional | 56 · Pre-op care only | $4.37 | $5.25 | $5.50 |
Oscar Health Setting Professional Modifier None Typical Low $64.57 Median $66.07 Typical High $70.79 | Professional | None | $64.57 | $66.07 | $70.79 |
UPMC Health Plan Setting Facility Modifier None Typical Low $48.98 Median $169.82 Typical High $331.13 | Facility | None | $48.98 | $169.82 | $331.13 |
UPMC Health Plan Setting Professional Modifier None Typical Low $48.98 Median $57.54 Typical High $66.07 | Professional | None | $48.98 | $57.54 | $66.07 |
United Setting Facility Modifier None Typical Low $70.79 Median $141.25 Typical High $1,230.27 | Facility | None | $70.79 | $141.25 | $1,230.27 |
United Setting Professional Modifier None Typical Low $44.67 Median $60.26 Typical High $107.15 | Professional | None | $44.67 | $60.26 | $107.15 |
1 more rate 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 59 · Distinct service Typical Low $64.57 Median $64.57 Typical High $64.57 | Professional | 59 · Distinct service | $64.57 | $64.57 | $64.57 |
Where Pennsylvania sits
The same service costs 4.8 times more in Alaska than in Kentucky. 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
$61.66
AK $240KY $50.12
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.