How much rates vary
Facilitymedian $2,754 · 10th to 90th $141 to $8,318Professionalmedian $115 · 10th to 90th $50 to $186
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 $85.11 Median $2,630.27 Typical High $8,511.38 | Facility | None | $85.11 | $2,630.27 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $51.29 Median $117.49 Typical High $173.78 | Professional | None | $51.29 | $117.49 | $173.78 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $25.70 Median $39.81 Typical High $72.44 | Professional | 52 · Reduced service | $25.70 | $39.81 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $15.85 Typical High $28.84 | Professional | 53 · Discontinued | $10.23 | $15.85 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $58.88 Typical High $107.15 | Professional | 54 · Surgery only | $38.02 | $58.88 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $11.75 Typical High $21.88 | Professional | 55 · Aftercare only | $7.76 | $11.75 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $7.94 Typical High $14.45 | Professional | 56 · Pre-op care only | $5.13 | $7.94 | $14.45 |
AmeriHealth Setting Facility Modifier None Typical Low $2,951.21 Median $3,715.35 Typical High $12,302.69 | Facility | None | $2,951.21 | $3,715.35 | $12,302.69 |
AmeriHealth Setting Professional Modifier None Typical Low $66.07 Median $954.99 Typical High $1,148.15 | Professional | None | $66.07 | $954.99 | $1,148.15 |
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 $114.82 Median $114.82 Typical High $147.91 | Professional | None | $114.82 | $114.82 | $147.91 |
Cigna Setting Professional Modifier None Typical Low $45.71 Median $107.15 Typical High $199.53 | Professional | None | $45.71 | $107.15 | $199.53 |
Emblem Health Setting Professional Modifier None Typical Low $154.88 Median $181.97 Typical High $199.53 | Professional | None | $154.88 | $181.97 | $199.53 |
Geisinger Setting Professional Modifier None Typical Low $58.88 Median $158.49 Typical High $275.42 | Professional | None | $58.88 | $158.49 | $275.42 |
Highmark BCBS Setting Facility Modifier None Typical Low $457.09 Median $870.96 Typical High $6,606.93 | Facility | None | $457.09 | $870.96 | $6,606.93 |
Highmark BCBS Setting Professional Modifier None Typical Low $53.70 Median $57.54 Typical High $66.07 | Professional | None | $53.70 | $57.54 | $66.07 |
Independence Blue Cross Setting Facility Modifier None Typical Low $2,511.89 Median $3,715.35 Typical High $11,748.98 | Facility | None | $2,511.89 | $3,715.35 | $11,748.98 |
Independence Blue Cross Setting Professional Modifier None Typical Low $64.57 Median $954.99 Typical High $1,148.15 | Professional | None | $64.57 | $954.99 | $1,148.15 |
Martin's Point Setting Facility Modifier None Typical Low $85.11 Median $2,570.40 Typical High $8,709.64 | Facility | None | $85.11 | $2,570.40 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $51.29 Median $117.49 Typical High $169.82 | Professional | None | $51.29 | $117.49 | $169.82 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $25.70 Median $38.90 Typical High $72.44 | Professional | 52 · Reduced service | $25.70 | $38.90 | $72.44 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $15.49 Typical High $28.84 | Professional | 53 · Discontinued | $10.23 | $15.49 | $28.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $58.88 Typical High $107.15 | Professional | 54 · Surgery only | $38.02 | $58.88 | $107.15 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $11.75 Typical High $21.88 | Professional | 55 · Aftercare only | $7.76 | $11.75 | $21.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $7.76 Typical High $14.45 | Professional | 56 · Pre-op care only | $5.13 | $7.76 | $14.45 |
Oscar Health Setting Professional Modifier None Typical Low $67.61 Median $128.82 Typical High $363.08 | Professional | None | $67.61 | $128.82 | $363.08 |
UPMC Health Plan Setting Facility Modifier None Typical Low $46.77 Median $389.05 Typical High $707.95 | Facility | None | $46.77 | $389.05 | $707.95 |
UPMC Health Plan Setting Professional Modifier None Typical Low $46.77 Median $60.26 Typical High $112.20 | Professional | None | $46.77 | $60.26 | $112.20 |
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 $46.77 Median $104.71 Typical High $223.87 | Professional | None | $46.77 | $104.71 | $223.87 |
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 76 · Repeat, same provider Typical Low $69.18 Median $69.18 Typical High $69.18 | Professional | 76 · Repeat, same provider | $69.18 | $69.18 | $69.18 |
Where Pennsylvania sits
The same service costs 2.8 times more in Wisconsin than in Florida. 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· 36th of 51
$115
WI $234FL $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.