How much rates vary
Facilitymedian $2,692 · 10th to 90th $676 to $6,607Professionalmedian $209 · 10th to 90th $174 to $398
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 $660.69 Median $4,073.80 Typical High $8,511.38 | Facility | None | $660.69 | $4,073.80 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $194.98 Typical High $223.87 | Professional | None | $173.78 | $194.98 | $223.87 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $56,234.13 | Facility | None | $3,981.07 | $7,413.10 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $186.21 Median $323.59 Typical High $398.11 | Professional | None | $186.21 | $323.59 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $2,344.23 Typical High $4,677.35 | Facility | None | $537.03 | $2,344.23 | $4,677.35 |
Cigna Setting Professional Modifier None Typical Low $181.97 Median $213.80 Typical High $407.38 | Professional | None | $181.97 | $213.80 | $407.38 |
Emblem Health Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $263.03 | Professional | None | $245.47 | $245.47 | $263.03 |
Geisinger Setting Facility Modifier None Typical Low $2,344.23 Median $2,884.03 Typical High $5,128.61 | Facility | None | $2,344.23 | $2,884.03 | $5,128.61 |
Geisinger Setting Professional Modifier None Typical Low $162.18 Median $218.78 Typical High $346.74 | Professional | None | $162.18 | $218.78 | $346.74 |
Highmark BCBS Setting Facility Modifier None Typical Low $6,918.31 Median $6,918.31 Typical High $6,918.31 | Facility | None | $6,918.31 | $6,918.31 | $6,918.31 |
Martin's Point Setting Facility Modifier None Typical Low $724.44 Median $3,801.89 Typical High $8,317.64 | Facility | None | $724.44 | $3,801.89 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $173.78 Median $194.98 Typical High $223.87 | Professional | None | $173.78 | $194.98 | $223.87 |
Oscar Health Setting Professional Modifier None Typical Low $194.98 Median $199.53 Typical High $316.23 | Professional | None | $194.98 | $199.53 | $316.23 |
UPMC Health Plan Setting Facility Modifier None Typical Low $169.82 Median $169.82 Typical High $186.21 | Facility | None | $169.82 | $169.82 | $186.21 |
UPMC Health Plan Setting Professional Modifier None Typical Low $169.82 Median $169.82 Typical High $186.21 | Professional | None | $169.82 | $169.82 | $186.21 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,398.83 Typical High $6,760.83 | Facility | None | $1,380.38 | $2,398.83 | $6,760.83 |
United Setting Professional Modifier None Typical Low $186.21 Median $229.09 Typical High $398.11 | Professional | None | $186.21 | $229.09 | $398.11 |
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 $87.10 Median $97.72 Typical High $100.00 | Professional | 52 · Reduced service | $87.10 | $97.72 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $38.90 Typical High $39.81 | Professional | 53 · Discontinued | $35.48 | $38.90 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $144.54 Typical High $151.36 | Professional | 54 · Surgery only | $131.83 | $144.54 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $28.84 Typical High $30.20 | Professional | 55 · Aftercare only | $26.30 | $28.84 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $19.50 Typical High $19.95 | Professional | 56 · Pre-op care only | $17.38 | $19.50 | $19.95 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $87.10 Median $97.72 Typical High $97.72 | Professional | 52 · Reduced service | $87.10 | $97.72 | $97.72 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $38.90 Typical High $38.90 | Professional | 53 · Discontinued | $35.48 | $38.90 | $38.90 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $144.54 Typical High $144.54 | Professional | 54 · Surgery only | $131.83 | $144.54 | $144.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $28.84 Typical High $28.84 | Professional | 55 · Aftercare only | $26.30 | $28.84 | $28.84 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $19.50 Typical High $19.50 | Professional | 56 · Pre-op care only | $17.38 | $19.50 | $19.50 |
Where Pennsylvania sits
The same service costs 10.2 times more in Oklahoma than in Kentucky. 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
$263
OK $1,950KY $191
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.