How much rates vary
Facilitymedian $525 · 10th to 90th $54 to $5,248Professionalmedian $17 · 10th to 90th $13 to $26
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 $16.60 Median $1,584.89 Typical High $7,244.36 | Facility | None | $16.60 | $1,584.89 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $13.18 Median $16.60 Typical High $29.51 | Professional | None | $13.18 | $16.60 | $29.51 |
Ambetter Setting Professional Modifier None Typical Low $13.18 Median $15.49 Typical High $31.62 | Professional | None | $13.18 | $15.49 | $31.62 |
AmeriHealth Setting Facility Modifier None Typical Low $691.83 Median $3,890.45 Typical High $5,888.44 | Facility | None | $691.83 | $3,890.45 | $5,888.44 |
AmeriHealth Setting Professional Modifier None Typical Low $7.94 Median $14.13 Typical High $18.20 | Professional | None | $7.94 | $14.13 | $18.20 |
Capital Blue Cross Setting Facility Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $56,234.13 | Facility | None | $1,202.26 | $1,412.54 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $14.79 Median $22.91 Typical High $26.30 | Professional | None | $14.79 | $22.91 | $26.30 |
Cigna Setting Facility Modifier None Typical Low $66.07 Median $562.34 Typical High $851.14 | Facility | None | $66.07 | $562.34 | $851.14 |
Cigna Setting Professional Modifier None Typical Low $12.30 Median $14.79 Typical High $26.30 | Professional | None | $12.30 | $14.79 | $26.30 |
Emblem Health Setting Professional Modifier None Typical Low $28.84 Median $28.84 Typical High $29.51 | Professional | None | $28.84 | $28.84 | $29.51 |
Geisinger Setting Professional Modifier None Typical Low $12.88 Median $19.95 Typical High $28.18 | Professional | None | $12.88 | $19.95 | $28.18 |
Highmark BCBS Setting Facility Modifier None Typical Low $25.70 Median $173.78 Typical High $309.03 | Facility | None | $25.70 | $173.78 | $309.03 |
Independence Blue Cross Setting Facility Modifier None Typical Low $85.11 Median $2,691.53 Typical High $5,888.44 | Facility | None | $85.11 | $2,691.53 | $5,888.44 |
Independence Blue Cross Setting Professional Modifier None Typical Low $7.94 Median $8.32 Typical High $16.98 | Professional | None | $7.94 | $8.32 | $16.98 |
Martin's Point Setting Facility Modifier None Typical Low $22.39 Median $1,584.89 Typical High $6,165.95 | Facility | None | $22.39 | $1,584.89 | $6,165.95 |
Martin's Point Setting Professional Modifier None Typical Low $13.18 Median $16.60 Typical High $29.51 | Professional | None | $13.18 | $16.60 | $29.51 |
Oscar Health Setting Facility Modifier None Typical Low $204.17 Median $204.17 Typical High $1,047.13 | Facility | None | $204.17 | $204.17 | $1,047.13 |
Oscar Health Setting Professional Modifier None Typical Low $14.45 Median $15.14 Typical High $28.84 | Professional | None | $14.45 | $15.14 | $28.84 |
UPMC Health Plan Setting Facility Modifier None Typical Low $13.18 Median $117.49 Typical High $181.97 | Facility | None | $13.18 | $117.49 | $181.97 |
UPMC Health Plan Setting Professional Modifier None Typical Low $13.18 Median $13.18 Typical High $14.45 | Professional | None | $13.18 | $13.18 | $14.45 |
United Setting Facility Modifier None Typical Low $75.86 Median $151.36 Typical High $1,230.27 | Facility | None | $75.86 | $151.36 | $1,230.27 |
United Setting Professional Modifier None Typical Low $12.30 Median $16.60 Typical High $28.18 | Professional | None | $12.30 | $16.60 | $28.18 |
11 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 $6.61 Median $7.59 Typical High $8.32 | Professional | 52 · Reduced service | $6.61 | $7.59 | $8.32 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.63 Median $3.02 Typical High $3.31 | Professional | 53 · Discontinued | $2.63 | $3.02 | $3.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $9.77 Median $11.22 Typical High $12.30 | Professional | 54 · Surgery only | $9.77 | $11.22 | $12.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.95 Median $2.24 Typical High $2.51 | Professional | 55 · Aftercare only | $1.95 | $2.24 | $2.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.32 Median $1.51 Typical High $1.66 | Professional | 56 · Pre-op care only | $1.32 | $1.51 | $1.66 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $22.39 Median $34.67 Typical High $39.81 | Professional | 50 · Both sides | $22.39 | $34.67 | $39.81 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $6.61 Median $7.76 Typical High $8.32 | Professional | 52 · Reduced service | $6.61 | $7.76 | $8.32 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.63 Median $3.09 Typical High $3.31 | Professional | 53 · Discontinued | $2.63 | $3.09 | $3.31 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $9.77 Median $11.75 Typical High $12.30 | Professional | 54 · Surgery only | $9.77 | $11.75 | $12.30 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.95 Median $2.34 Typical High $2.51 | Professional | 55 · Aftercare only | $1.95 | $2.34 | $2.51 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.32 Median $1.55 Typical High $1.66 | Professional | 56 · Pre-op care only | $1.32 | $1.55 | $1.66 |
Where Pennsylvania sits
The same service costs 7.4 times more in Kansas 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· 42nd of 51
$18.62
KS $95.50KY $12.88
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.