How much rates vary
Facilitymedian $141 · 10th to 90th $98 to $1,096Professionalmedian $117 · 10th to 90th $85 to $204
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 $85.11 Median $85.11 Typical High $93.33 | Facility | None | $85.11 | $85.11 | $93.33 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $93.33 Typical High $97.72 | Professional | None | $85.11 | $93.33 | $97.72 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $42.66 Median $46.77 Typical High $48.98 | Professional | 52 · Reduced service | $42.66 | $46.77 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $18.62 Typical High $19.95 | Professional | 53 · Discontinued | $16.98 | $18.62 | $19.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $14.13 Typical High $14.79 | Professional | 55 · Aftercare only | $12.59 | $14.13 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $9.33 Typical High $9.77 | Professional | 56 · Pre-op care only | $8.51 | $9.33 | $9.77 |
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 $165.96 Median $204.17 Typical High $204.17 | Professional | None | $165.96 | $204.17 | $204.17 |
Cigna Setting Facility Modifier None Typical Low $141.25 Median $141.25 Typical High $141.25 | Facility | None | $141.25 | $141.25 | $141.25 |
Cigna Setting Professional Modifier None Typical Low $102.33 Median $102.33 Typical High $1,023.29 | Professional | None | $102.33 | $102.33 | $1,023.29 |
Emblem Health Setting Professional Modifier None Typical Low $190.55 Median $302.00 Typical High $354.81 | Professional | None | $190.55 | $302.00 | $354.81 |
Geisinger Setting Facility Modifier None Typical Low $208.93 Median $208.93 Typical High $208.93 | Facility | None | $208.93 | $208.93 | $208.93 |
Geisinger Setting Professional Modifier None Typical Low $125.89 Median $134.90 Typical High $208.93 | Professional | None | $125.89 | $134.90 | $208.93 |
Highmark BCBS Setting Facility Modifier None Typical Low $97.72 Median $169.82 Typical High $234.42 | Facility | None | $97.72 | $169.82 | $234.42 |
Highmark BCBS Setting Professional Modifier None Typical Low $144.54 Median $165.96 Typical High $177.83 | Professional | None | $144.54 | $165.96 | $177.83 |
Martin's Point Setting Facility Modifier None Typical Low $85.11 Median $85.11 Typical High $85.11 | Facility | None | $85.11 | $85.11 | $85.11 |
Martin's Point Setting Professional Modifier None Typical Low $85.11 Median $93.33 Typical High $97.72 | Professional | None | $85.11 | $93.33 | $97.72 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $42.66 Median $46.77 Typical High $48.98 | Professional | 52 · Reduced service | $42.66 | $46.77 | $48.98 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $18.62 Typical High $19.95 | Professional | 53 · Discontinued | $16.98 | $18.62 | $19.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $14.13 Typical High $14.79 | Professional | 55 · Aftercare only | $12.59 | $14.13 | $14.79 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $9.33 Typical High $9.77 | Professional | 56 · Pre-op care only | $8.51 | $9.33 | $9.77 |
Oscar Health Setting Professional Modifier None Typical Low $109.65 Median $109.65 Typical High $295.12 | Professional | None | $109.65 | $109.65 | $295.12 |
UPMC Health Plan Setting Facility Modifier None Typical Low $131.83 Median $660.69 Typical High $1,148.15 | Facility | None | $131.83 | $660.69 | $1,148.15 |
UPMC Health Plan Setting Professional Modifier None Typical Low $131.83 Median $131.83 Typical High $194.98 | Professional | None | $131.83 | $131.83 | $194.98 |
United Setting Facility Modifier None Typical Low $257.04 Median $257.04 Typical High $309.03 | Facility | None | $257.04 | $257.04 | $309.03 |
United Setting Professional Modifier None Typical Low $79.43 Median $102.33 Typical High $169.82 | Professional | None | $79.43 | $102.33 | $169.82 |
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 $186.21 Median $204.17 Typical High $204.17 | Professional | 50 · Both sides | $186.21 | $204.17 | $204.17 |
Highmark BCBS Setting Professional Modifier KX · Policy requirements met Typical Low $144.54 Median $162.18 Typical High $165.96 | Professional | KX · Policy requirements met | $144.54 | $162.18 | $165.96 |
Where Pennsylvania sits
The same service costs 2.0 times more in Wyoming 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· 26th of 51
$126
WY $209NJ $102
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.