How much rates vary
Facilitymedian $832 · 10th to 90th $398 to $4,074Professionalmedian $158 · 10th to 90th $115 to $166
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 $478.63 Median $2,344.23 Typical High $8,317.64 | Facility | None | $478.63 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $114.82 Median $128.82 Typical High $131.83 | Professional | None | $114.82 | $128.82 | $131.83 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $56,234.13 | Facility | None | $3,981.07 | $4,365.16 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $165.96 | Professional | None | $158.49 | $158.49 | $165.96 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $758.58 Typical High $1,348.96 | Facility | None | $501.19 | $758.58 | $1,348.96 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $117.49 Typical High $257.04 | Professional | None | $114.82 | $117.49 | $257.04 |
Emblem Health Setting Professional Modifier None Typical Low $295.12 Median $407.38 Typical High $524.81 | Professional | None | $295.12 | $407.38 | $524.81 |
Geisinger Setting Facility Modifier None Typical Low $645.65 Median $794.33 Typical High $1,412.54 | Facility | None | $645.65 | $794.33 | $1,412.54 |
Martin's Point Setting Facility Modifier None Typical Low $537.03 Median $2,344.23 Typical High $7,244.36 | Facility | None | $537.03 | $2,344.23 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $114.82 Median $128.82 Typical High $131.83 | Professional | None | $114.82 | $128.82 | $131.83 |
Oscar Health Setting Professional Modifier None Typical Low $204.17 Median $239.88 Typical High $239.88 | Professional | None | $204.17 | $239.88 | $239.88 |
UPMC Health Plan Setting Facility Modifier None Typical Low $50.12 Median $239.88 Typical High $467.74 | Facility | None | $50.12 | $239.88 | $467.74 |
UPMC Health Plan Setting Professional Modifier None Typical Low $50.12 Median $50.12 Typical High $151.36 | Professional | None | $50.12 | $50.12 | $151.36 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,467.37 | Facility | None | $416.87 | $724.44 | $3,467.37 |
United Setting Professional Modifier None Typical Low $107.15 Median $123.03 Typical High $194.98 | Professional | None | $107.15 | $123.03 | $194.98 |
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 $57.54 Median $63.10 Typical High $66.07 | Professional | 52 · Reduced service | $57.54 | $63.10 | $66.07 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $25.70 Typical High $26.30 | Professional | 53 · Discontinued | $22.91 | $25.70 | $26.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $95.50 Typical High $97.72 | Professional | 54 · Surgery only | $87.10 | $95.50 | $97.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $19.05 Typical High $19.95 | Professional | 55 · Aftercare only | $17.38 | $19.05 | $19.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $12.88 Typical High $13.18 | Professional | 56 · Pre-op care only | $11.48 | $12.88 | $13.18 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $57.54 Median $63.10 Typical High $66.07 | Professional | 52 · Reduced service | $57.54 | $63.10 | $66.07 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $25.70 Typical High $26.30 | Professional | 53 · Discontinued | $22.91 | $25.70 | $26.30 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $95.50 Typical High $97.72 | Professional | 54 · Surgery only | $87.10 | $95.50 | $97.72 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $19.05 Typical High $19.95 | Professional | 55 · Aftercare only | $17.38 | $19.05 | $19.95 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $12.88 Typical High $13.18 | Professional | 56 · Pre-op care only | $11.48 | $12.88 | $13.18 |
Where Pennsylvania sits
The same service costs 6.0 times more in Alaska 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· 25th of 51
$158
AK $501KY $83.18
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.