How much rates vary
Facilitymedian $525 · 10th to 90th $115 to $4,266Professionalmedian $138 · 10th to 90th $66 to $245
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 $66.07 Median $1,819.70 Typical High $7,244.36 | Facility | None | $66.07 | $1,819.70 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $66.07 Median $125.89 Typical High $186.21 | Professional | None | $66.07 | $125.89 | $186.21 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $30.90 Median $47.86 Typical High $70.79 | Professional | 52 · Reduced service | $30.90 | $47.86 | $70.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.59 Median $19.50 Typical High $28.84 | Professional | 53 · Discontinued | $12.59 | $19.50 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $46.77 Median $72.44 Typical High $107.15 | Professional | 54 · Surgery only | $46.77 | $72.44 | $107.15 |
Ambetter Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $229.09 | Professional | None | $223.87 | $223.87 | $229.09 |
AmeriHealth Setting Facility Modifier None Typical Low $2,290.87 Median $3,162.28 Typical High $9,549.93 | Facility | None | $2,290.87 | $3,162.28 | $9,549.93 |
AmeriHealth Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $257.04 | Professional | None | $162.18 | $162.18 | $257.04 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,630.27 Median $2,818.38 Typical High $8,709.64 | Facility | None | $2,630.27 | $2,818.38 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $147.91 Median $234.42 Typical High $309.03 | Professional | None | $147.91 | $234.42 | $309.03 |
Cigna Setting Facility Modifier None Typical Low $114.82 Median $288.40 Typical High $549.54 | Facility | None | $114.82 | $288.40 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $70.79 Median $134.90 Typical High $239.88 | Professional | None | $70.79 | $134.90 | $239.88 |
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 $102.33 Median $128.82 Typical High $223.87 | Facility | None | $102.33 | $128.82 | $223.87 |
Geisinger Setting Professional Modifier None Typical Low $74.13 Median $158.49 Typical High $257.04 | Professional | None | $74.13 | $158.49 | $257.04 |
Highmark BCBS Setting Facility Modifier None Typical Low $107.15 Median $3,019.95 Typical High $4,786.30 | Facility | None | $107.15 | $3,019.95 | $4,786.30 |
Independence Blue Cross Setting Facility Modifier None Typical Low $1,318.26 Median $3,090.30 Typical High $7,585.78 | Facility | None | $1,318.26 | $3,090.30 | $7,585.78 |
Independence Blue Cross Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $208.93 | Professional | None | $162.18 | $162.18 | $208.93 |
Martin's Point Setting Facility Modifier None Typical Low $66.07 Median $1,584.89 Typical High $6,165.95 | Facility | None | $66.07 | $1,584.89 | $6,165.95 |
Martin's Point Setting Professional Modifier None Typical Low $66.07 Median $125.89 Typical High $190.55 | Professional | None | $66.07 | $125.89 | $190.55 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $30.20 Median $47.86 Typical High $70.79 | Professional | 52 · Reduced service | $30.20 | $47.86 | $70.79 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $19.50 Typical High $28.84 | Professional | 53 · Discontinued | $12.02 | $19.50 | $28.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $44.67 Median $72.44 Typical High $107.15 | Professional | 54 · Surgery only | $44.67 | $72.44 | $107.15 |
Oscar Health Setting Professional Modifier None Typical Low $123.03 Median $131.83 Typical High $275.42 | Professional | None | $123.03 | $131.83 | $275.42 |
UPMC Health Plan Setting Facility Modifier None Typical Low $91.20 Median $1,995.26 Typical High $4,570.88 | Facility | None | $91.20 | $1,995.26 | $4,570.88 |
UPMC Health Plan Setting Professional Modifier None Typical Low $72.44 Median $138.04 Typical High $147.91 | Professional | None | $72.44 | $138.04 | $147.91 |
United Setting Facility Modifier None Typical Low $199.53 Median $436.52 Typical High $2,290.87 | Facility | None | $199.53 | $436.52 | $2,290.87 |
United Setting Professional Modifier None Typical Low $70.79 Median $131.83 Typical High $229.09 | Professional | None | $70.79 | $131.83 | $229.09 |
4 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 55 · Aftercare only Typical Low $9.33 Median $14.45 Typical High $21.38 | Professional | 55 · Aftercare only | $9.33 | $14.45 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.31 Median $9.55 Typical High $14.45 | Professional | 56 · Pre-op care only | $6.31 | $9.55 | $14.45 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $8.91 Median $14.45 Typical High $21.38 | Professional | 55 · Aftercare only | $8.91 | $14.45 | $21.38 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.03 Median $9.55 Typical High $14.45 | Professional | 56 · Pre-op care only | $6.03 | $9.55 | $14.45 |
Where Pennsylvania sits
The same service costs 3.3 times more in Wisconsin 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· 35th of 51
$145
WI $372KY $112
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.