How much rates vary
Facilitymedian $1,175 · 10th to 90th $871 to $7,943Professionalmedian $1,000 · 10th to 90th $832 to $1,905
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 $831.76 Median $831.76 Typical High $912.01 | Facility | None | $831.76 | $831.76 | $912.01 |
Aetna Setting Professional Modifier None Typical Low $831.76 Median $912.01 Typical High $954.99 | Professional | None | $831.76 | $912.01 | $954.99 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $407.38 Median $457.09 Typical High $478.63 | Professional | 52 · Reduced service | $407.38 | $457.09 | $478.63 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $165.96 Median $181.97 Typical High $194.98 | Professional | 53 · Discontinued | $165.96 | $181.97 | $194.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $123.03 Median $138.04 Typical High $144.54 | Professional | 55 · Aftercare only | $123.03 | $138.04 | $144.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $91.20 Typical High $95.50 | Professional | 56 · Pre-op care only | $83.18 | $91.20 | $95.50 |
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 $1,513.56 Median $1,584.89 Typical High $1,819.70 | Professional | None | $1,513.56 | $1,584.89 | $1,819.70 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,819.70 Median $1,995.26 Typical High $1,995.26 | Professional | 50 · Both sides | $1,819.70 | $1,995.26 | $1,995.26 |
Cigna Setting Facility Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,174.90 | Facility | None | $1,174.90 | $1,174.90 | $1,174.90 |
Cigna Setting Professional Modifier None Typical Low $851.14 Median $851.14 Typical High $10,471.29 | Professional | None | $851.14 | $851.14 | $10,471.29 |
Emblem Health Setting Professional Modifier None Typical Low $2,290.87 Median $3,548.13 Typical High $4,168.69 | Professional | None | $2,290.87 | $3,548.13 | $4,168.69 |
Geisinger Setting Facility Modifier None Typical Low $2,041.74 Median $2,041.74 Typical High $2,041.74 | Facility | None | $2,041.74 | $2,041.74 | $2,041.74 |
Geisinger Setting Professional Modifier None Typical Low $1,047.13 Median $1,230.27 Typical High $2,041.74 | Professional | None | $1,047.13 | $1,230.27 | $2,041.74 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $831.76 Typical High $831.76 | Facility | None | $831.76 | $831.76 | $831.76 |
Martin's Point Setting Professional Modifier None Typical Low $831.76 Median $912.01 Typical High $954.99 | Professional | None | $831.76 | $912.01 | $954.99 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $407.38 Median $457.09 Typical High $478.63 | Professional | 52 · Reduced service | $407.38 | $457.09 | $478.63 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $165.96 Median $181.97 Typical High $194.98 | Professional | 53 · Discontinued | $165.96 | $181.97 | $194.98 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $123.03 Median $138.04 Typical High $144.54 | Professional | 55 · Aftercare only | $123.03 | $138.04 | $144.54 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $91.20 Typical High $95.50 | Professional | 56 · Pre-op care only | $83.18 | $91.20 | $95.50 |
Oscar Health Setting Professional Modifier None Typical Low $1,513.56 Median $3,467.37 Typical High $3,630.78 | Professional | None | $1,513.56 | $3,467.37 | $3,630.78 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,445.44 Median $6,456.54 Typical High $11,220.18 | Facility | None | $1,445.44 | $6,456.54 | $11,220.18 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,445.44 Median $1,445.44 Typical High $1,905.46 | Professional | None | $1,445.44 | $1,445.44 | $1,905.46 |
United Setting Facility Modifier None Typical Low $870.96 Median $933.25 Typical High $3,090.30 | Facility | None | $870.96 | $933.25 | $3,090.30 |
United Setting Professional Modifier None Typical Low $776.25 Median $1,000.00 Typical High $1,659.59 | Professional | None | $776.25 | $1,000.00 | $1,659.59 |
1 more rate 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 |
|---|---|---|---|---|---|
Highmark BCBS Setting Professional Modifier KX · Policy requirements met Typical Low $1,513.56 Median $1,513.56 Typical High $1,513.56 | Professional | KX · Policy requirements met | $1,513.56 | $1,513.56 | $1,513.56 |
Where Pennsylvania sits
The same service costs 3.0 times more in Montana than in Delaware. 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· 49th of 51
$1,000
MT $2,570DE $851
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.