How much rates vary
Facilitymedian $1,072 · 10th to 90th $490 to $4,898Professionalmedian $170 · 10th to 90th $145 to $316
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 $645.65 Median $3,235.94 Typical High $8,511.38 | Facility | None | $645.65 | $3,235.94 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $158.49 Typical High $158.49 | Professional | None | $144.54 | $158.49 | $158.49 |
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 $151.36 Median $257.04 Typical High $316.23 | Professional | None | $151.36 | $257.04 | $316.23 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $954.99 Typical High $1,819.70 | Facility | None | $501.19 | $954.99 | $1,819.70 |
Cigna Setting Professional Modifier None Typical Low $144.54 Median $173.78 Typical High $316.23 | Professional | None | $144.54 | $173.78 | $316.23 |
Emblem Health Setting Professional Modifier None Typical Low $151.36 Median $213.80 Typical High $269.15 | Professional | None | $151.36 | $213.80 | $269.15 |
Geisinger Setting Facility Modifier None Typical Low $870.96 Median $1,096.48 Typical High $1,905.46 | Facility | None | $870.96 | $1,096.48 | $1,905.46 |
Geisinger Setting Professional Modifier None Typical Low $138.04 Median $173.78 Typical High $239.88 | Professional | None | $138.04 | $173.78 | $239.88 |
Martin's Point Setting Facility Modifier None Typical Low $724.44 Median $2,754.23 Typical High $8,317.64 | Facility | None | $724.44 | $2,754.23 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $144.54 Median $158.49 Typical High $158.49 | Professional | None | $144.54 | $158.49 | $158.49 |
Oscar Health Setting Professional Modifier None Typical Low $165.96 Median $251.19 Typical High $588.84 | Professional | None | $165.96 | $251.19 | $588.84 |
UPMC Health Plan Setting Facility Modifier None Typical Low $151.36 Median $177.83 Typical High $177.83 | Facility | None | $151.36 | $177.83 | $177.83 |
UPMC Health Plan Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $177.83 | Professional | None | $151.36 | $151.36 | $177.83 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,890.45 | Facility | None | $416.87 | $724.44 | $3,890.45 |
United Setting Professional Modifier None Typical Low $134.90 Median $158.49 Typical High $251.19 | Professional | None | $134.90 | $158.49 | $251.19 |
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 $70.79 Median $79.43 Typical High $79.43 | Professional | 52 · Reduced service | $70.79 | $79.43 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $31.62 Typical High $31.62 | Professional | 53 · Discontinued | $28.84 | $31.62 | $31.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $117.49 Typical High $120.23 | Professional | 54 · Surgery only | $107.15 | $117.49 | $120.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $23.99 Typical High $23.99 | Professional | 55 · Aftercare only | $21.38 | $23.99 | $23.99 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $15.85 Typical High $15.85 | Professional | 56 · Pre-op care only | $14.45 | $15.85 | $15.85 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $70.79 Median $79.43 Typical High $79.43 | Professional | 52 · Reduced service | $70.79 | $79.43 | $79.43 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $31.62 Typical High $31.62 | Professional | 53 · Discontinued | $28.84 | $31.62 | $31.62 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $117.49 Typical High $120.23 | Professional | 54 · Surgery only | $107.15 | $117.49 | $120.23 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $23.99 Typical High $23.99 | Professional | 55 · Aftercare only | $21.38 | $23.99 | $23.99 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $15.85 Typical High $15.85 | Professional | 56 · Pre-op care only | $14.45 | $15.85 | $15.85 |
Where Pennsylvania sits
The same service costs 11.1 times more in Colorado than in Montana. 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.
Physician feeFacility fee
CO $5,221MT $469
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.