How much rates vary
Facilitymedian $1,585 · 10th to 90th $372 to $6,607Professionalmedian $525 · 10th to 90th $162 to $891
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 $537.03 Median $2,344.23 Typical High $8,511.38 | Facility | None | $537.03 | $2,344.23 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $426.58 Typical High $691.83 | Professional | None | $162.18 | $426.58 | $691.83 |
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 $512.86 Median $524.81 Typical High $977.24 | Professional | None | $512.86 | $524.81 | $977.24 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $758.58 Median $794.33 Typical High $1,479.11 | Professional | 50 · Both sides | $758.58 | $794.33 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $144.54 Median $380.19 Typical High $758.58 | Professional | None | $144.54 | $380.19 | $758.58 |
Emblem Health Setting Professional Modifier None Typical Low $707.95 Median $851.14 Typical High $912.01 | Professional | None | $707.95 | $851.14 | $912.01 |
Geisinger Setting Professional Modifier None Typical Low $181.97 Median $562.34 Typical High $1,071.52 | Professional | None | $181.97 | $562.34 | $1,071.52 |
Martin's Point Setting Facility Modifier None Typical Low $588.84 Median $2,344.23 Typical High $8,511.38 | Facility | None | $588.84 | $2,344.23 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $162.18 Median $501.19 Typical High $691.83 | Professional | None | $162.18 | $501.19 | $691.83 |
Oscar Health Setting Professional Modifier None Typical Low $213.80 Median $602.56 Typical High $1,174.90 | Professional | None | $213.80 | $602.56 | $1,174.90 |
UPMC Health Plan Setting Facility Modifier None Typical Low $213.80 Median $1,000.00 Typical High $1,778.28 | Facility | None | $213.80 | $1,000.00 | $1,778.28 |
UPMC Health Plan Setting Professional Modifier None Typical Low $147.91 Median $489.78 Typical High $537.03 | Professional | None | $147.91 | $489.78 | $537.03 |
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 $144.54 Median $331.13 Typical High $831.76 | Professional | None | $144.54 | $331.13 | $831.76 |
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 $81.28 Median $123.03 Typical High $346.74 | Professional | 52 · Reduced service | $81.28 | $123.03 | $346.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $48.98 Typical High $138.04 | Professional | 53 · Discontinued | $32.36 | $48.98 | $138.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $186.21 Typical High $512.86 | Professional | 54 · Surgery only | $123.03 | $186.21 | $512.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $37.15 Typical High $102.33 | Professional | 55 · Aftercare only | $24.55 | $37.15 | $102.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $24.55 Typical High $69.18 | Professional | 56 · Pre-op care only | $16.22 | $24.55 | $69.18 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $81.28 Median $120.23 Typical High $346.74 | Professional | 52 · Reduced service | $81.28 | $120.23 | $346.74 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $47.86 Typical High $138.04 | Professional | 53 · Discontinued | $32.36 | $47.86 | $138.04 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $177.83 Typical High $512.86 | Professional | 54 · Surgery only | $123.03 | $177.83 | $512.86 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $35.48 Typical High $102.33 | Professional | 55 · Aftercare only | $24.55 | $35.48 | $102.33 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $23.99 Typical High $69.18 | Professional | 56 · Pre-op care only | $16.22 | $23.99 | $69.18 |
Where Pennsylvania sits
The same service costs 3.5 times more in Wisconsin 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· 21st of 51
$525
WI $912NE $257
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.