How much rates vary
Facilitymedian $91 · 10th to 90th $10 to $309Professionalmedian $19 · 10th to 90th $10 to $32
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 $10.00 Median $63.10 Typical High $239.88 | Facility | None | $10.00 | $63.10 | $239.88 |
Aetna Setting Professional Modifier None Typical Low $10.00 Median $10.00 Typical High $29.51 | Professional | None | $10.00 | $10.00 | $29.51 |
Ambetter Setting Professional Modifier None Typical Low $18.20 Median $28.18 Typical High $41.69 | Professional | None | $18.20 | $28.18 | $41.69 |
AmeriHealth Setting Professional Modifier None Typical Low $18.62 Median $21.88 Typical High $22.91 | Professional | None | $18.62 | $21.88 | $22.91 |
Capital Blue Cross Setting Facility Modifier None Typical Low $4,265.80 Median $5,011.87 Typical High $79,432.82 | Facility | None | $4,265.80 | $5,011.87 | $79,432.82 |
Capital Blue Cross Setting Professional Modifier None Typical Low $19.50 Median $19.50 Typical High $44.67 | Professional | None | $19.50 | $19.50 | $44.67 |
Cigna Setting Professional Modifier None Typical Low $14.79 Median $20.89 Typical High $30.20 | Professional | None | $14.79 | $20.89 | $30.20 |
Geisinger Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $37.15 | Professional | None | $30.90 | $30.90 | $37.15 |
Highmark BCBS Setting Facility Modifier None Typical Low $19.95 Median $134.90 Typical High $269.15 | Facility | None | $19.95 | $134.90 | $269.15 |
Independence Blue Cross Setting Professional Modifier None Typical Low $18.62 Median $21.88 Typical High $22.91 | Professional | None | $18.62 | $21.88 | $22.91 |
Martin's Point Setting Facility Modifier None Typical Low $10.00 Median $64.57 Typical High $239.88 | Facility | None | $10.00 | $64.57 | $239.88 |
Martin's Point Setting Professional Modifier None Typical Low $10.00 Median $10.00 Typical High $29.51 | Professional | None | $10.00 | $10.00 | $29.51 |
Oscar Health Setting Facility Modifier None Typical Low $316.23 Median $331.13 Typical High $457.09 | Facility | None | $316.23 | $331.13 | $457.09 |
UPMC Health Plan Setting Facility Modifier None Typical Low $0.79 Median $1.48 Typical High $20.89 | Facility | None | $0.79 | $1.48 | $20.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $19.50 Median $20.89 Typical High $20.89 | Professional | None | $19.50 | $20.89 | $20.89 |
United Setting Facility Modifier None Typical Low $100.00 Median $208.93 Typical High $245.47 | Facility | None | $100.00 | $208.93 | $245.47 |
United Setting Professional Modifier None Typical Low $13.80 Median $17.38 Typical High $27.54 | Professional | None | $13.80 | $17.38 | $27.54 |
8 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 $5.01 Median $5.01 Typical High $5.01 | Professional | 52 · Reduced service | $5.01 | $5.01 | $5.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.00 Median $2.00 Typical High $2.00 | Professional | 53 · Discontinued | $2.00 | $2.00 | $2.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.51 Median $1.51 Typical High $1.51 | Professional | 55 · Aftercare only | $1.51 | $1.51 | $1.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | 56 · Pre-op care only | $1.00 | $1.00 | $1.00 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $5.01 Median $5.01 Typical High $5.01 | Professional | 52 · Reduced service | $5.01 | $5.01 | $5.01 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.00 Median $2.00 Typical High $2.00 | Professional | 53 · Discontinued | $2.00 | $2.00 | $2.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.51 Median $1.51 Typical High $1.51 | Professional | 55 · Aftercare only | $1.51 | $1.51 | $1.51 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.00 Median $1.00 Typical High $1.00 | Professional | 56 · Pre-op care only | $1.00 | $1.00 | $1.00 |
Where Pennsylvania sits
The same service costs 5.4 times more in Vermont than in Kansas. 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· 33rd of 51
$22.91
VT $75.86KS $14.13
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.