How much rates vary
Facilitymedian $603 · 10th to 90th $63 to $5,754Professionalmedian $240 · 10th to 90th $50 to $562
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 $60.26 Median $891.25 Typical High $6,165.95 | Facility | None | $60.26 | $891.25 | $6,165.95 |
Aetna Setting Professional Modifier None Typical Low $50.12 Median $251.19 Typical High $371.54 | Professional | None | $50.12 | $251.19 | $371.54 |
Ambetter Setting Professional Modifier None Typical Low $26.30 Median $26.30 Typical High $26.30 | Professional | None | $26.30 | $26.30 | $26.30 |
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 $234.42 Median $239.88 Typical High $616.60 | Professional | None | $234.42 | $239.88 | $616.60 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $346.74 Median $363.08 Typical High $912.01 | Professional | 50 · Both sides | $346.74 | $363.08 | $912.01 |
Cigna Setting Professional Modifier None Typical Low $45.71 Median $151.36 Typical High $416.87 | Professional | None | $45.71 | $151.36 | $416.87 |
Emblem Health Setting Professional Modifier None Typical Low $338.84 Median $407.38 Typical High $426.58 | Professional | None | $338.84 | $407.38 | $426.58 |
Geisinger Setting Professional Modifier None Typical Low $56.23 Median $323.59 Typical High $549.54 | Professional | None | $56.23 | $323.59 | $549.54 |
Highmark BCBS Setting Professional Modifier None Typical Low $66.07 Median $66.07 Typical High $91.20 | Professional | None | $66.07 | $66.07 | $91.20 |
Martin's Point Setting Facility Modifier None Typical Low $63.10 Median $1,071.52 Typical High $6,165.95 | Facility | None | $63.10 | $1,071.52 | $6,165.95 |
Martin's Point Setting Professional Modifier None Typical Low $50.12 Median $257.04 Typical High $354.81 | Professional | None | $50.12 | $257.04 | $354.81 |
Oscar Health Setting Professional Modifier None Typical Low $446.68 Median $588.84 Typical High $758.58 | Professional | None | $446.68 | $588.84 | $758.58 |
UPMC Health Plan Setting Facility Modifier None Typical Low $125.89 Median $229.09 Typical High $1,174.90 | Facility | None | $125.89 | $229.09 | $1,174.90 |
UPMC Health Plan Setting Professional Modifier None Typical Low $46.77 Median $239.88 Typical High $1,174.90 | Professional | None | $46.77 | $239.88 | $1,174.90 |
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 $44.67 Median $239.88 Typical High $467.74 | Professional | None | $44.67 | $239.88 | $467.74 |
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 $25.12 Median $38.02 Typical High $162.18 | Professional | 52 · Reduced service | $25.12 | $38.02 | $162.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $15.14 Typical High $64.57 | Professional | 53 · Discontinued | $10.23 | $15.14 | $64.57 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $56.23 Typical High $245.47 | Professional | 54 · Surgery only | $38.02 | $56.23 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $34.67 Typical High $48.98 | Professional | 55 · Aftercare only | $7.59 | $34.67 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $22.91 Typical High $32.36 | Professional | 56 · Pre-op care only | $5.13 | $22.91 | $32.36 |
Highmark BCBS Setting Facility Modifier XS · Separate structure Typical Low $1,230.27 Median $1,230.27 Typical High $1,230.27 | Facility | XS · Separate structure | $1,230.27 | $1,230.27 | $1,230.27 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $25.12 Median $38.02 Typical High $162.18 | Professional | 52 · Reduced service | $25.12 | $38.02 | $162.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $15.14 Typical High $64.57 | Professional | 53 · Discontinued | $10.23 | $15.14 | $64.57 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $56.23 Typical High $245.47 | Professional | 54 · Surgery only | $38.02 | $56.23 | $245.47 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $34.67 Typical High $48.98 | Professional | 55 · Aftercare only | $7.59 | $34.67 | $48.98 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $32.36 Typical High $33.11 | Professional | 56 · Pre-op care only | $28.18 | $32.36 | $33.11 |
Where Pennsylvania sits
The same service costs 4.9 times more in Iowa 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· 34th of 51
$240
IA $417NE $85.11
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.