How much rates vary
Facilitymedian $138 · 10th to 90th $9 to $490Professionalmedian $155 · 10th to 90th $16 to $240
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 $8.71 Median $16.22 Typical High $186.21 | Facility | None | $8.71 | $16.22 | $186.21 |
Aetna Setting Professional Modifier None Typical Low $16.22 Median $147.91 Typical High $213.80 | Professional | None | $16.22 | $147.91 | $213.80 |
Ambetter Setting Professional Modifier None Typical Low $134.90 Median $134.90 Typical High $134.90 | Professional | None | $134.90 | $134.90 | $134.90 |
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 $141.25 Median $141.25 Typical High $141.25 | Professional | None | $141.25 | $141.25 | $141.25 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $144.54 Median $309.03 Typical High $338.84 | Professional | 50 · Both sides | $144.54 | $309.03 | $338.84 |
Cigna Setting Professional Modifier None Typical Low $128.82 Median $165.96 Typical High $251.19 | Professional | None | $128.82 | $165.96 | $251.19 |
Emblem Health Setting Facility Modifier None Typical Low $95.50 Median $95.50 Typical High $95.50 | Facility | None | $95.50 | $95.50 | $95.50 |
Emblem Health Setting Professional Modifier None Typical Low $162.18 Median $223.87 Typical High $331.13 | Professional | None | $162.18 | $223.87 | $331.13 |
Geisinger Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $346.74 | Professional | None | $199.53 | $199.53 | $346.74 |
Highmark BCBS Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | None | $151.36 | $151.36 | $151.36 |
Martin's Point Setting Facility Modifier None Typical Low $8.71 Median $16.22 Typical High $186.21 | Facility | None | $8.71 | $16.22 | $186.21 |
Martin's Point Setting Professional Modifier None Typical Low $16.22 Median $147.91 Typical High $208.93 | Professional | None | $16.22 | $147.91 | $208.93 |
Optum Setting Professional Modifier None Typical Low $66.07 Median $138.04 Typical High $186.21 | Professional | None | $66.07 | $138.04 | $186.21 |
Oscar Health Setting Professional Modifier None Typical Low $123.03 Median $138.04 Typical High $288.40 | Professional | None | $123.03 | $138.04 | $288.40 |
UPMC Health Plan Setting Facility Modifier None Typical Low $181.97 Median $346.74 Typical High $489.78 | Facility | None | $181.97 | $346.74 | $489.78 |
UPMC Health Plan Setting Professional Modifier None Typical Low $181.97 Median $181.97 Typical High $181.97 | Professional | None | $181.97 | $181.97 | $181.97 |
United Setting Professional Modifier None Typical Low $138.04 Median $173.78 Typical High $316.23 | Professional | None | $138.04 | $173.78 | $316.23 |
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 Facility Modifier 52 · Reduced service Typical Low $4.37 Median $4.68 Typical High $8.13 | Facility | 52 · Reduced service | $4.37 | $4.68 | $8.13 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $8.13 Median $8.13 Typical High $77.62 | Professional | 52 · Reduced service | $8.13 | $8.13 | $77.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $22.39 Typical High $25.70 | Professional | 55 · Aftercare only | $18.62 | $22.39 | $25.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $15.14 Typical High $16.98 | Professional | 56 · Pre-op care only | $12.30 | $15.14 | $16.98 |
Martin's Point Setting Facility Modifier 52 · Reduced service Typical Low $4.37 Median $4.68 Typical High $8.13 | Facility | 52 · Reduced service | $4.37 | $4.68 | $8.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $8.13 Median $8.13 Typical High $75.86 | Professional | 52 · Reduced service | $8.13 | $8.13 | $75.86 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $22.91 Typical High $24.55 | Professional | 55 · Aftercare only | $18.20 | $22.91 | $24.55 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $15.14 Typical High $16.22 | Professional | 56 · Pre-op care only | $12.02 | $15.14 | $16.22 |
Where Pennsylvania sits
The same service costs 2.4 times more in Alaska than in Alabama. 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· 31st of 51
$155
AK $288AL $120
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.