How much rates vary
Facilitymedian $138 · 10th to 90th $68 to $575Professionalmedian $69 · 10th to 90th $47 to $112
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 $46.77 Median $85.11 Typical High $630.96 | Facility | None | $46.77 | $85.11 | $630.96 |
Aetna Setting Professional Modifier None Typical Low $46.77 Median $51.29 Typical High $66.07 | Professional | None | $46.77 | $51.29 | $66.07 |
Ambetter Setting Professional Modifier None Typical Low $63.10 Median $87.10 Typical High $87.10 | Professional | None | $63.10 | $87.10 | $87.10 |
AmeriHealth Setting Professional Modifier None Typical Low $66.07 Median $85.11 Typical High $85.11 | Professional | None | $66.07 | $85.11 | $85.11 |
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 $91.20 Median $112.20 Typical High $112.20 | Professional | None | $91.20 | $112.20 | $112.20 |
Cigna Setting Facility Modifier None Typical Low $67.61 Median $67.61 Typical High $72.44 | Facility | None | $67.61 | $67.61 | $72.44 |
Cigna Setting Professional Modifier None Typical Low $50.12 Median $50.12 Typical High $562.34 | Professional | None | $50.12 | $50.12 | $562.34 |
Emblem Health Setting Professional Modifier None Typical Low $95.50 Median $147.91 Typical High $173.78 | Professional | None | $95.50 | $147.91 | $173.78 |
Geisinger Setting Facility Modifier None Typical Low $114.82 Median $114.82 Typical High $114.82 | Facility | None | $114.82 | $114.82 | $114.82 |
Geisinger Setting Professional Modifier None Typical Low $60.26 Median $69.18 Typical High $114.82 | Professional | None | $60.26 | $69.18 | $114.82 |
Highmark BCBS Setting Facility Modifier None Typical Low $213.80 Median $371.54 Typical High $489.78 | Facility | None | $213.80 | $371.54 | $489.78 |
Highmark BCBS Setting Professional Modifier None Typical Low $79.43 Median $85.11 Typical High $112.20 | Professional | None | $79.43 | $85.11 | $112.20 |
Independence Blue Cross Setting Professional Modifier None Typical Low $66.07 Median $66.07 Typical High $85.11 | Professional | None | $66.07 | $66.07 | $85.11 |
Martin's Point Setting Facility Modifier None Typical Low $46.77 Median $57.54 Typical High $630.96 | Facility | None | $46.77 | $57.54 | $630.96 |
Martin's Point Setting Professional Modifier None Typical Low $46.77 Median $51.29 Typical High $64.57 | Professional | None | $46.77 | $51.29 | $64.57 |
Oscar Health Setting Professional Modifier None Typical Low $25.12 Median $25.12 Typical High $144.54 | Professional | None | $25.12 | $25.12 | $144.54 |
UPMC Health Plan Setting Facility Modifier None Typical Low $77.62 Median $251.19 Typical High $549.54 | Facility | None | $77.62 | $251.19 | $549.54 |
UPMC Health Plan Setting Professional Modifier None Typical Low $72.44 Median $77.62 Typical High $107.15 | Professional | None | $72.44 | $77.62 | $107.15 |
United Setting Facility Modifier None Typical Low $67.61 Median $77.62 Typical High $165.96 | Facility | None | $67.61 | $77.62 | $165.96 |
United Setting Professional Modifier None Typical Low $43.65 Median $56.23 Typical High $93.33 | Professional | None | $43.65 | $56.23 | $93.33 |
10 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 $23.44 Median $25.70 Typical High $26.92 | Professional | 52 · Reduced service | $23.44 | $25.70 | $26.92 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $10.23 Typical High $10.96 | Professional | 53 · Discontinued | $9.33 | $10.23 | $10.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.92 Median $7.76 Typical High $8.13 | Professional | 55 · Aftercare only | $6.92 | $7.76 | $8.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $5.13 Typical High $5.37 | Professional | 56 · Pre-op care only | $4.68 | $5.13 | $5.37 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $102.33 Median $112.20 Typical High $112.20 | Professional | 50 · Both sides | $102.33 | $112.20 | $112.20 |
Highmark BCBS Setting Professional Modifier KX · Policy requirements met Typical Low $79.43 Median $85.11 Typical High $95.50 | Professional | KX · Policy requirements met | $79.43 | $85.11 | $95.50 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $23.44 Median $25.70 Typical High $26.92 | Professional | 52 · Reduced service | $23.44 | $25.70 | $26.92 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $10.23 Typical High $10.96 | Professional | 53 · Discontinued | $9.33 | $10.23 | $10.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $6.92 Median $7.76 Typical High $8.13 | Professional | 55 · Aftercare only | $6.92 | $7.76 | $8.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $5.13 Typical High $5.37 | Professional | 56 · Pre-op care only | $4.68 | $5.13 | $5.37 |
Where Pennsylvania sits
The same service costs 4.1 times more in Hawaii 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· 23rd of 51
$72.44
HI $209DE $51.29
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.