How much rates vary
Facilitymedian $537 · 10th to 90th $50 to $16,596Professionalmedian $6 · 10th to 90th $2 to $10
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 $5.75 Median $1,995.26 Typical High $7,943.28 | Facility | None | $5.75 | $1,995.26 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $1.78 Median $5.75 Typical High $8.51 | Professional | None | $1.78 | $5.75 | $8.51 |
Ambetter Setting Professional Modifier None Typical Low $5.37 Median $5.37 Typical High $8.91 | Professional | None | $5.37 | $5.37 | $8.91 |
AmeriHealth Setting Facility Modifier None Typical Low $9,772.37 Median $22,908.68 Typical High $33,884.42 | Facility | None | $9,772.37 | $22,908.68 | $33,884.42 |
AmeriHealth Setting Professional Modifier None Typical Low $1.86 Median $5.13 Typical High $6.03 | Professional | None | $1.86 | $5.13 | $6.03 |
Capital Blue Cross Setting Facility Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $56,234.13 | Facility | None | $1,202.26 | $1,412.54 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $6.46 Median $6.76 Typical High $13.49 | Professional | None | $6.46 | $6.76 | $13.49 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $100.00 Typical High $2,290.87 | Facility | None | $50.12 | $100.00 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1.86 Median $5.75 Typical High $9.77 | Professional | None | $1.86 | $5.75 | $9.77 |
Emblem Health Setting Professional Modifier None Typical Low $10.72 Median $10.72 Typical High $10.72 | Professional | None | $10.72 | $10.72 | $10.72 |
Geisinger Setting Professional Modifier None Typical Low $5.62 Median $8.91 Typical High $13.18 | Professional | None | $5.62 | $8.91 | $13.18 |
Highmark BCBS Setting Facility Modifier None Typical Low $15.49 Median $30.20 Typical High $47.86 | Facility | None | $15.49 | $30.20 | $47.86 |
Highmark BCBS Setting Professional Modifier None Typical Low $5.13 Median $7.08 Typical High $11.22 | Professional | None | $5.13 | $7.08 | $11.22 |
Independence Blue Cross Setting Facility Modifier None Typical Low $9,772.37 Median $18,620.87 Typical High $33,884.42 | Facility | None | $9,772.37 | $18,620.87 | $33,884.42 |
Independence Blue Cross Setting Professional Modifier None Typical Low $1.86 Median $6.03 Typical High $6.03 | Professional | None | $1.86 | $6.03 | $6.03 |
Martin's Point Setting Facility Modifier None Typical Low $6.03 Median $1,819.70 Typical High $6,606.93 | Facility | None | $6.03 | $1,819.70 | $6,606.93 |
Martin's Point Setting Professional Modifier None Typical Low $1.78 Median $5.75 Typical High $8.51 | Professional | None | $1.78 | $5.75 | $8.51 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $16.60 Typical High $16.60 | Professional | None | $15.14 | $16.60 | $16.60 |
UPMC Health Plan Setting Facility Modifier None Typical Low $6.46 Median $75.86 Typical High $144.54 | Facility | None | $6.46 | $75.86 | $144.54 |
UPMC Health Plan Setting Professional Modifier None Typical Low $2.00 Median $6.46 Typical High $14.13 | Professional | None | $2.00 | $6.46 | $14.13 |
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 $1.86 Median $5.25 Typical High $9.55 | Professional | None | $1.86 | $5.25 | $9.55 |
11 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 52 · Reduced service Typical Low $0.89 Median $2.45 Typical High $3.09 | Professional | 52 · Reduced service | $0.89 | $2.45 | $3.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.36 Median $1.15 Typical High $1.26 | Professional | 53 · Discontinued | $0.36 | $1.15 | $1.26 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1.35 Median $3.63 Typical High $4.68 | Professional | 54 · Surgery only | $1.35 | $3.63 | $4.68 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.27 Median $0.87 Typical High $0.93 | Professional | 55 · Aftercare only | $0.27 | $0.87 | $0.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.18 Median $0.58 Typical High $0.62 | Professional | 56 · Pre-op care only | $0.18 | $0.58 | $0.62 |
Highmark BCBS Setting Professional Modifier 59 · Distinct service Typical Low $5.89 Median $6.31 Typical High $7.41 | Professional | 59 · Distinct service | $5.89 | $6.31 | $7.41 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $0.89 Median $2.88 Typical High $3.09 | Professional | 52 · Reduced service | $0.89 | $2.88 | $3.09 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.36 Median $1.15 Typical High $1.26 | Professional | 53 · Discontinued | $0.36 | $1.15 | $1.26 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1.35 Median $2.69 Typical High $4.68 | Professional | 54 · Surgery only | $1.35 | $2.69 | $4.68 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.27 Median $0.87 Typical High $0.93 | Professional | 55 · Aftercare only | $0.27 | $0.87 | $0.93 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.58 Median $0.62 Typical High $0.62 | Professional | 56 · Pre-op care only | $0.58 | $0.62 | $0.62 |
Where Pennsylvania sits
The same service costs 3.0 times more in Alaska than in Nebraska. 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· 38th of 51
$6.03
AK $12.88NE $4.37
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.