How much rates vary
Facilitymedian $380 · 10th to 90th $282 to $4,266Professionalmedian $417 · 10th to 90th $309 to $708
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $331.13 Median $380.19 Typical High $446.68 | Facility | None | $331.13 | $380.19 | $446.68 |
Aetna Setting Professional Modifier None Typical Low $309.03 Median $354.81 Typical High $446.68 | Professional | None | $309.03 | $354.81 | $446.68 |
Ambetter Setting Professional Modifier None Typical Low $436.52 Median $436.52 Typical High $512.86 | Professional | None | $436.52 | $436.52 | $512.86 |
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 $467.74 Median $616.60 Typical High $812.83 | Professional | None | $467.74 | $616.60 | $812.83 |
Cigna Setting Professional Modifier None Typical Low $457.09 Median $457.09 Typical High $457.09 | Professional | None | $457.09 | $457.09 | $457.09 |
Emblem Health Setting Professional Modifier None Typical Low $575.44 Median $741.31 Typical High $1,000.00 | Professional | None | $575.44 | $741.31 | $1,000.00 |
Geisinger Setting Professional Modifier None Typical Low $354.81 Median $501.19 Typical High $851.14 | Professional | None | $354.81 | $501.19 | $851.14 |
Highmark BCBS Setting Professional Modifier None Typical Low $75.86 Median $97.72 Typical High $524.81 | Professional | None | $75.86 | $97.72 | $524.81 |
Martin's Point Setting Facility Modifier None Typical Low $331.13 Median $380.19 Typical High $446.68 | Facility | None | $331.13 | $380.19 | $446.68 |
Martin's Point Setting Professional Modifier None Typical Low $309.03 Median $354.81 Typical High $446.68 | Professional | None | $309.03 | $354.81 | $446.68 |
Optum Setting Professional Modifier None Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | None | $416.87 | $416.87 | $416.87 |
Oscar Health Setting Professional Modifier None Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | None | $416.87 | $416.87 | $416.87 |
UPMC Health Plan Setting Facility Modifier None Typical Low $281.84 Median $380.19 Typical High $446.68 | Facility | None | $281.84 | $380.19 | $446.68 |
UPMC Health Plan Setting Professional Modifier None Typical Low $281.84 Median $380.19 Typical High $446.68 | Professional | None | $281.84 | $380.19 | $446.68 |
United Setting Facility Modifier None Typical Low $245.47 Median $524.81 Typical High $602.56 | Facility | None | $245.47 | $524.81 | $602.56 |
United Setting Professional Modifier None Typical Low $263.03 Median $363.08 Typical High $512.86 | Professional | None | $263.03 | $363.08 | $512.86 |
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 $194.98 Median $208.93 Typical High $223.87 | Professional | 52 · Reduced service | $194.98 | $208.93 | $223.87 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $77.62 Median $83.18 Typical High $89.13 | Professional | 53 · Discontinued | $77.62 | $83.18 | $89.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $57.54 Median $61.66 Typical High $67.61 | Professional | 55 · Aftercare only | $57.54 | $61.66 | $67.61 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $38.90 Median $41.69 Typical High $44.67 | Professional | 56 · Pre-op care only | $38.90 | $41.69 | $44.67 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $208.93 Median $208.93 Typical High $223.87 | Professional | 52 · Reduced service | $208.93 | $208.93 | $223.87 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $83.18 Typical High $89.13 | Professional | 53 · Discontinued | $83.18 | $83.18 | $89.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $61.66 Typical High $67.61 | Professional | 55 · Aftercare only | $61.66 | $61.66 | $67.61 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $41.69 Typical High $44.67 | Professional | 56 · Pre-op care only | $41.69 | $41.69 | $44.67 |
Where Pennsylvania sits
The same service costs 2.1 times more in Wyoming than in Maryland. 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· 24th of 51
$417
WY $661MD $309
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.