How much rates vary
Facilitymedian $98 · 10th to 90th $79 to $871Professionalmedian $98 · 10th to 90th $71 to $174
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 $70.79 Median $70.79 Typical High $128.82 | Facility | None | $70.79 | $70.79 | $128.82 |
Aetna Setting Professional Modifier None Typical Low $70.79 Median $77.62 Typical High $100.00 | Professional | None | $70.79 | $77.62 | $100.00 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $35.48 Median $38.90 Typical High $41.69 | Professional | 52 · Reduced service | $35.48 | $38.90 | $41.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.13 Median $15.49 Typical High $16.60 | Professional | 53 · Discontinued | $14.13 | $15.49 | $16.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.72 Median $11.75 Typical High $12.30 | Professional | 55 · Aftercare only | $10.72 | $11.75 | $12.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.08 Median $7.76 Typical High $8.32 | Professional | 56 · Pre-op care only | $7.08 | $7.76 | $8.32 |
Ambetter Setting Professional Modifier None Typical Low $97.72 Median $97.72 Typical High $147.91 | Professional | None | $97.72 | $97.72 | $147.91 |
AmeriHealth Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $128.82 | Professional | None | $128.82 | $128.82 | $128.82 |
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 $138.04 Median $173.78 Typical High $173.78 | Professional | None | $138.04 | $173.78 | $173.78 |
Cigna Setting Facility Modifier None Typical Low $95.50 Median $97.72 Typical High $97.72 | Facility | None | $95.50 | $97.72 | $97.72 |
Cigna Setting Professional Modifier None Typical Low $70.79 Median $70.79 Typical High $812.83 | Professional | None | $70.79 | $70.79 | $812.83 |
Emblem Health Setting Professional Modifier None Typical Low $154.88 Median $245.47 Typical High $281.84 | Professional | None | $154.88 | $245.47 | $281.84 |
Geisinger Setting Facility Modifier None Typical Low $173.78 Median $173.78 Typical High $173.78 | Facility | None | $173.78 | $173.78 | $173.78 |
Geisinger Setting Professional Modifier None Typical Low $91.20 Median $104.71 Typical High $173.78 | Professional | None | $91.20 | $104.71 | $173.78 |
Highmark BCBS Setting Facility Modifier None Typical Low $34.67 Median $34.67 Typical High $93.33 | Facility | None | $34.67 | $34.67 | $93.33 |
Highmark BCBS Setting Professional Modifier None Typical Low $120.23 Median $141.25 Typical High $173.78 | Professional | None | $120.23 | $141.25 | $173.78 |
Independence Blue Cross Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $131.83 | Professional | None | $128.82 | $128.82 | $131.83 |
Martin's Point Setting Facility Modifier None Typical Low $70.79 Median $70.79 Typical High $128.82 | Facility | None | $70.79 | $70.79 | $128.82 |
Martin's Point Setting Professional Modifier None Typical Low $70.79 Median $77.62 Typical High $95.50 | Professional | None | $70.79 | $77.62 | $95.50 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $35.48 Median $38.90 Typical High $41.69 | Professional | 52 · Reduced service | $35.48 | $38.90 | $41.69 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $14.13 Median $15.49 Typical High $16.60 | Professional | 53 · Discontinued | $14.13 | $15.49 | $16.60 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $10.72 Median $11.75 Typical High $12.30 | Professional | 55 · Aftercare only | $10.72 | $11.75 | $12.30 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $7.08 Median $7.76 Typical High $8.32 | Professional | 56 · Pre-op care only | $7.08 | $7.76 | $8.32 |
Oscar Health Setting Professional Modifier None Typical Low $102.33 Median $102.33 Typical High $234.42 | Professional | None | $102.33 | $102.33 | $234.42 |
UPMC Health Plan Setting Facility Modifier None Typical Low $120.23 Median $562.34 Typical High $954.99 | Facility | None | $120.23 | $562.34 | $954.99 |
UPMC Health Plan Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $162.18 | Professional | None | $120.23 | $120.23 | $162.18 |
United Setting Facility Modifier None Typical Low $79.43 Median $89.13 Typical High $239.88 | Facility | None | $79.43 | $89.13 | $239.88 |
United Setting Professional Modifier None Typical Low $66.07 Median $85.11 Typical High $134.90 | Professional | None | $66.07 | $85.11 | $134.90 |
2 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 |
|---|---|---|---|---|---|
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $154.88 Median $173.78 Typical High $173.78 | Professional | 50 · Both sides | $154.88 | $173.78 | $173.78 |
Highmark BCBS Setting Professional Modifier KX · Policy requirements met Typical Low $120.23 Median $128.82 Typical High $141.25 | Professional | KX · Policy requirements met | $120.23 | $128.82 | $141.25 |
Where Pennsylvania sits
The same service costs 2.8 times more in Hawaii than in Florida. 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· 26th of 51
$97.72
HI $195FL $70.79
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.