How much rates vary
Facilitymedian $1,995 · 10th to 90th $479 to $7,943Professionalmedian $288 · 10th to 90th $240 to $525
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 $2,344.23 Typical High $8,317.64 | Facility | None | $537.03 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $239.88 Median $269.15 Typical High $269.15 | Professional | None | $239.88 | $269.15 | $269.15 |
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 $257.04 Median $436.52 Typical High $537.03 | Professional | None | $257.04 | $436.52 | $537.03 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $3,311.31 Typical High $7,762.47 | Facility | None | $501.19 | $3,311.31 | $7,762.47 |
Cigna Setting Professional Modifier None Typical Low $251.19 Median $288.40 Typical High $512.86 | Professional | None | $251.19 | $288.40 | $512.86 |
Emblem Health Setting Professional Modifier None Typical Low $269.15 Median $363.08 Typical High $489.78 | Professional | None | $269.15 | $363.08 | $489.78 |
Geisinger Setting Facility Modifier None Typical Low $4,677.35 Median $5,754.40 Typical High $10,232.93 | Facility | None | $4,677.35 | $5,754.40 | $10,232.93 |
Geisinger Setting Professional Modifier None Typical Low $234.42 Median $295.12 Typical High $407.38 | Professional | None | $234.42 | $295.12 | $407.38 |
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 $239.88 Median $269.15 Typical High $269.15 | Professional | None | $239.88 | $269.15 | $269.15 |
Oscar Health Setting Professional Modifier None Typical Low $281.84 Median $426.58 Typical High $1,000.00 | Professional | None | $281.84 | $426.58 | $1,000.00 |
UPMC Health Plan Setting Facility Modifier None Typical Low $251.19 Median $302.00 Typical High $302.00 | Facility | None | $251.19 | $302.00 | $302.00 |
UPMC Health Plan Setting Professional Modifier None Typical Low $251.19 Median $257.04 Typical High $302.00 | Professional | None | $251.19 | $257.04 | $302.00 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $5,011.87 | Facility | None | $416.87 | $724.44 | $5,011.87 |
United Setting Professional Modifier None Typical Low $229.09 Median $269.15 Typical High $416.87 | Professional | None | $229.09 | $269.15 | $416.87 |
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 $120.23 Median $134.90 Typical High $134.90 | Professional | 52 · Reduced service | $120.23 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $48.98 Median $53.70 Typical High $53.70 | Professional | 53 · Discontinued | $48.98 | $53.70 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $181.97 Median $199.53 Typical High $204.17 | Professional | 54 · Surgery only | $181.97 | $199.53 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $36.31 Median $39.81 Typical High $40.74 | Professional | 55 · Aftercare only | $36.31 | $39.81 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.99 Median $26.92 Typical High $26.92 | Professional | 56 · Pre-op care only | $23.99 | $26.92 | $26.92 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $120.23 Median $134.90 Typical High $134.90 | Professional | 52 · Reduced service | $120.23 | $134.90 | $134.90 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $48.98 Median $53.70 Typical High $53.70 | Professional | 53 · Discontinued | $48.98 | $53.70 | $53.70 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $181.97 Median $199.53 Typical High $204.17 | Professional | 54 · Surgery only | $181.97 | $199.53 | $204.17 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $36.31 Median $39.81 Typical High $40.74 | Professional | 55 · Aftercare only | $36.31 | $39.81 | $40.74 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $23.99 Median $26.92 Typical High $26.92 | Professional | 56 · Pre-op care only | $23.99 | $26.92 | $26.92 |
Where Pennsylvania sits
The same service costs 4.3 times more in Alaska 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· 39th of 51
$288
AK $1,047FL $245
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.