How much rates vary
Facilitymedian $316 · 10th to 90th $51 to $4,898Professionalmedian $48 · 10th to 90th $38 to $89
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 $2,454.71 Typical High $8,317.64 | Facility | None | $537.03 | $2,454.71 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $42.66 Median $47.86 Typical High $69.18 | Professional | None | $42.66 | $47.86 | $69.18 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $5,011.87 Typical High $56,234.13 | Facility | None | $3,981.07 | $5,011.87 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $38.90 Median $63.10 Typical High $79.43 | Professional | None | $38.90 | $63.10 | $79.43 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $120.23 | Facility | None | $50.12 | $66.07 | $120.23 |
Cigna Setting Professional Modifier None Typical Low $35.48 Median $42.66 Typical High $87.10 | Professional | None | $35.48 | $42.66 | $87.10 |
Emblem Health Setting Professional Modifier None Typical Low $51.29 Median $51.29 Typical High $54.95 | Professional | None | $51.29 | $51.29 | $54.95 |
Geisinger Setting Professional Modifier None Typical Low $38.02 Median $50.12 Typical High $81.28 | Professional | None | $38.02 | $50.12 | $81.28 |
Martin's Point Setting Facility Modifier None Typical Low $588.84 Median $2,344.23 Typical High $7,244.36 | Facility | None | $588.84 | $2,344.23 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $42.66 Median $47.86 Typical High $104.71 | Professional | None | $42.66 | $47.86 | $104.71 |
Oscar Health Setting Professional Modifier None Typical Low $3.02 Median $147.91 Typical High $158.49 | Professional | None | $3.02 | $147.91 | $158.49 |
UPMC Health Plan Setting Facility Modifier None Typical Low $33.11 Median $61.66 Typical High $151.36 | Facility | None | $33.11 | $61.66 | $151.36 |
UPMC Health Plan Setting Professional Modifier None Typical Low $38.90 Median $89.13 Typical High $151.36 | Professional | None | $38.90 | $89.13 | $151.36 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,445.44 | Facility | None | $77.62 | $158.49 | $1,445.44 |
United Setting Professional Modifier None Typical Low $36.31 Median $47.86 Typical High $81.28 | Professional | None | $36.31 | $47.86 | $81.28 |
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 $21.38 Median $23.44 Typical High $23.99 | Professional | 52 · Reduced service | $21.38 | $23.44 | $23.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.51 Median $9.55 Typical High $9.55 | Professional | 53 · Discontinued | $8.51 | $9.55 | $9.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $32.36 Median $35.48 Typical High $35.48 | Professional | 54 · Surgery only | $32.36 | $35.48 | $35.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.46 Median $7.08 Typical High $7.08 | Professional | 55 · Aftercare only | $6.46 | $7.08 | $7.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.27 Median $4.68 Typical High $4.79 | Professional | 56 · Pre-op care only | $4.27 | $4.68 | $4.79 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $21.38 Median $23.44 Typical High $23.99 | Professional | 52 · Reduced service | $21.38 | $23.44 | $23.99 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $8.51 Median $9.55 Typical High $9.55 | Professional | 53 · Discontinued | $8.51 | $9.55 | $9.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $32.36 Median $35.48 Typical High $35.48 | Professional | 54 · Surgery only | $32.36 | $35.48 | $35.48 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $6.46 Median $7.08 Typical High $7.08 | Professional | 55 · Aftercare only | $6.46 | $7.08 | $7.08 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.27 Median $4.68 Typical High $4.79 | Professional | 56 · Pre-op care only | $4.27 | $4.68 | $4.79 |
Where Pennsylvania sits
The same service costs 9.3 times more in Tennessee than in New York. 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· 42nd of 51
$54.95
TN $398NY $42.66
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.