How much rates vary
Facilitymedian $89 · 10th to 90th $78 to $155Professionalmedian $110 · 10th to 90th $79 to $195
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 $77.62 Median $85.11 Typical High $117.49 | Facility | None | $77.62 | $85.11 | $117.49 |
Aetna Setting Professional Modifier None Typical Low $79.43 Median $95.50 Typical High $162.18 | Professional | None | $79.43 | $95.50 | $162.18 |
Ambetter Setting Professional Modifier None Typical Low $91.20 Median $109.65 Typical High $173.78 | Professional | None | $91.20 | $109.65 | $173.78 |
AmeriHealth Setting Professional Modifier None Typical Low $89.13 Median $107.15 Typical High $125.89 | Professional | None | $89.13 | $107.15 | $125.89 |
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 $123.03 Median $186.21 Typical High $204.17 | Professional | None | $123.03 | $186.21 | $204.17 |
Cigna Setting Professional Modifier None Typical Low $89.13 Median $112.20 Typical High $186.21 | Professional | None | $89.13 | $112.20 | $186.21 |
Emblem Health Setting Facility Modifier None Typical Low $50.12 Median $50.12 Typical High $50.12 | Facility | None | $50.12 | $50.12 | $50.12 |
Emblem Health Setting Professional Modifier None Typical Low $51.29 Median $158.49 Typical High $223.87 | Professional | None | $51.29 | $158.49 | $223.87 |
Geisinger Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $107.15 | Facility | None | $89.13 | $89.13 | $107.15 |
Geisinger Setting Professional Modifier None Typical Low $85.11 Median $131.83 Typical High $199.53 | Professional | None | $85.11 | $131.83 | $199.53 |
Highmark BCBS Setting Professional Modifier None Typical Low $109.65 Median $123.03 Typical High $186.21 | Professional | None | $109.65 | $123.03 | $186.21 |
Independence Blue Cross Setting Professional Modifier None Typical Low $89.13 Median $107.15 Typical High $134.90 | Professional | None | $89.13 | $107.15 | $134.90 |
Martin's Point Setting Facility Modifier None Typical Low $77.62 Median $85.11 Typical High $117.49 | Facility | None | $77.62 | $85.11 | $117.49 |
Martin's Point Setting Professional Modifier None Typical Low $79.43 Median $93.33 Typical High $158.49 | Professional | None | $79.43 | $93.33 | $158.49 |
Optum Setting Professional Modifier None Typical Low $72.44 Median $120.23 Typical High $125.89 | Professional | None | $72.44 | $120.23 | $125.89 |
Oscar Health Setting Professional Modifier None Typical Low $85.11 Median $120.23 Typical High $199.53 | Professional | None | $85.11 | $120.23 | $199.53 |
UPMC Health Plan Setting Facility Modifier None Typical Low $93.33 Median $117.49 Typical High $165.96 | Facility | None | $93.33 | $117.49 | $165.96 |
UPMC Health Plan Setting Professional Modifier None Typical Low $107.15 Median $107.15 Typical High $117.49 | Professional | None | $107.15 | $107.15 | $117.49 |
United Setting Professional Modifier None Typical Low $85.11 Median $109.65 Typical High $194.98 | Professional | None | $85.11 | $109.65 | $194.98 |
16 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 Facility Modifier 52 · Reduced service Typical Low $38.90 Median $39.81 Typical High $44.67 | Facility | 52 · Reduced service | $38.90 | $39.81 | $44.67 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $11.75 Median $12.02 Typical High $13.49 | Facility | 55 · Aftercare only | $11.75 | $12.02 | $13.49 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $7.76 Median $7.94 Typical High $8.91 | Facility | 56 · Pre-op care only | $7.76 | $7.94 | $8.91 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $38.90 Median $39.81 Typical High $47.86 | Professional | 52 · Reduced service | $38.90 | $39.81 | $47.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.75 Median $12.02 Typical High $14.45 | Professional | 55 · Aftercare only | $11.75 | $12.02 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $7.94 Typical High $9.55 | Professional | 56 · Pre-op care only | $7.76 | $7.94 | $9.55 |
Ambetter Setting Professional Modifier 57 · Decision for surgery Typical Low $91.20 Median $91.20 Typical High $158.49 | Professional | 57 · Decision for surgery | $91.20 | $91.20 | $158.49 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $104.71 Median $154.88 Typical High $204.17 | Professional | GC · Resident with teaching physician | $104.71 | $154.88 | $204.17 |
Highmark BCBS Setting Professional Modifier FS · Shared visit Typical Low $107.15 Median $120.23 Typical High $151.36 | Professional | FS · Shared visit | $107.15 | $120.23 | $151.36 |
Highmark BCBS Setting Professional Modifier GC · Resident with teaching physician Typical Low $114.82 Median $151.36 Typical High $199.53 | Professional | GC · Resident with teaching physician | $114.82 | $151.36 | $199.53 |
Martin's Point Setting Facility Modifier 52 · Reduced service Typical Low $38.90 Median $39.81 Typical High $44.67 | Facility | 52 · Reduced service | $38.90 | $39.81 | $44.67 |
Martin's Point Setting Facility Modifier 55 · Aftercare only Typical Low $11.75 Median $12.02 Typical High $13.49 | Facility | 55 · Aftercare only | $11.75 | $12.02 | $13.49 |
Martin's Point Setting Facility Modifier 56 · Pre-op care only Typical Low $7.76 Median $7.94 Typical High $8.91 | Facility | 56 · Pre-op care only | $7.76 | $7.94 | $8.91 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $38.90 Median $39.81 Typical High $42.66 | Professional | 52 · Reduced service | $38.90 | $39.81 | $42.66 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $11.75 Median $12.02 Typical High $12.59 | Professional | 55 · Aftercare only | $11.75 | $12.02 | $12.59 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $7.94 Typical High $8.51 | Professional | 56 · Pre-op care only | $7.76 | $7.94 | $8.51 |
Where Pennsylvania sits
The same service costs 2.5 times more in Alaska than in New Jersey. 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· 30th of 51
$110
AK $229NJ $93.33
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.