How much rates vary
Facilitymedian $1,230 · 10th to 90th $105 to $6,166Professionalmedian $158 · 10th to 90th $68 to $302
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 $154.88 Median $2,344.23 Typical High $8,317.64 | Facility | None | $154.88 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $66.07 Median $131.83 Typical High $154.88 | Professional | None | $66.07 | $131.83 | $154.88 |
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 $158.49 Median $162.18 Typical High $316.23 | Professional | None | $158.49 | $162.18 | $316.23 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $234.42 Median $245.47 Typical High $478.63 | Professional | 50 · Both sides | $234.42 | $245.47 | $478.63 |
Cigna Setting Professional Modifier None Typical Low $72.44 Median $151.36 Typical High $239.88 | Professional | None | $72.44 | $151.36 | $239.88 |
Emblem Health Setting Professional Modifier None Typical Low $218.78 Median $263.03 Typical High $281.84 | Professional | None | $218.78 | $263.03 | $281.84 |
Geisinger Setting Professional Modifier None Typical Low $89.13 Median $177.83 Typical High $331.13 | Professional | None | $89.13 | $177.83 | $331.13 |
Martin's Point Setting Facility Modifier None Typical Low $478.63 Median $2,137.96 Typical High $7,244.36 | Facility | None | $478.63 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $66.07 Median $134.90 Typical High $154.88 | Professional | None | $66.07 | $134.90 | $154.88 |
Oscar Health Setting Professional Modifier None Typical Low $288.40 Median $363.08 Typical High $478.63 | Professional | None | $288.40 | $363.08 | $478.63 |
UPMC Health Plan Setting Facility Modifier None Typical Low $81.28 Median $147.91 Typical High $245.47 | Facility | None | $81.28 | $147.91 | $245.47 |
UPMC Health Plan Setting Professional Modifier None Typical Low $74.13 Median $158.49 Typical High $245.47 | Professional | None | $74.13 | $158.49 | $245.47 |
United Setting Facility Modifier None Typical Low $169.82 Median $524.81 Typical High $3,890.45 | Facility | None | $169.82 | $524.81 | $3,890.45 |
United Setting Professional Modifier None Typical Low $70.79 Median $147.91 Typical High $269.15 | Professional | None | $70.79 | $147.91 | $269.15 |
10 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 $33.11 Median $57.54 Typical High $75.86 | Professional | 52 · Reduced service | $33.11 | $57.54 | $75.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $23.44 Typical High $30.90 | Professional | 53 · Discontinued | $13.18 | $23.44 | $30.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $48.98 Median $87.10 Typical High $114.82 | Professional | 54 · Surgery only | $48.98 | $87.10 | $114.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $17.38 Typical High $22.91 | Professional | 55 · Aftercare only | $9.77 | $17.38 | $22.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $11.48 Typical High $15.49 | Professional | 56 · Pre-op care only | $6.61 | $11.48 | $15.49 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $33.11 Median $57.54 Typical High $75.86 | Professional | 52 · Reduced service | $33.11 | $57.54 | $75.86 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $23.44 Typical High $30.90 | Professional | 53 · Discontinued | $13.18 | $23.44 | $30.90 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $48.98 Median $87.10 Typical High $114.82 | Professional | 54 · Surgery only | $48.98 | $87.10 | $114.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $17.38 Typical High $22.91 | Professional | 55 · Aftercare only | $9.77 | $17.38 | $22.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $11.48 Typical High $15.49 | Professional | 56 · Pre-op care only | $6.61 | $11.48 | $15.49 |
Where Pennsylvania sits
The same service costs 2.6 times more in Wisconsin 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· 24th of 51
$158
WI $309UT $120
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.