How much rates vary
Facilitymedian $19 · 10th to 90th $13 to $93Professionalmedian $13 · 10th to 90th $12 to $26
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 $11.75 Median $11.75 Typical High $12.59 | Facility | None | $11.75 | $11.75 | $12.59 |
Aetna Setting Professional Modifier None Typical Low $11.75 Median $12.59 Typical High $12.88 | Professional | None | $11.75 | $12.59 | $12.88 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $5.89 Median $6.31 Typical High $6.46 | Professional | 52 · Reduced service | $5.89 | $6.31 | $6.46 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.34 Median $2.51 Typical High $2.63 | Professional | 53 · Discontinued | $2.34 | $2.51 | $2.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.78 Median $1.91 Typical High $1.95 | Professional | 55 · Aftercare only | $1.78 | $1.91 | $1.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.20 Median $1.26 Typical High $1.29 | Professional | 56 · Pre-op care only | $1.20 | $1.26 | $1.29 |
Ambetter Setting Professional Modifier None Typical Low $22.91 Median $22.91 Typical High $22.91 | Professional | None | $22.91 | $22.91 | $22.91 |
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 $21.38 Median $26.30 Typical High $26.30 | Professional | None | $21.38 | $26.30 | $26.30 |
Cigna Setting Facility Modifier None Typical Low $18.62 Median $18.62 Typical High $18.62 | Facility | None | $18.62 | $18.62 | $18.62 |
Cigna Setting Professional Modifier None Typical Low $13.49 Median $13.49 Typical High $147.91 | Professional | None | $13.49 | $13.49 | $147.91 |
Emblem Health Setting Professional Modifier None Typical Low $29.51 Median $45.71 Typical High $53.70 | Professional | None | $29.51 | $45.71 | $53.70 |
Geisinger Setting Facility Modifier None Typical Low $26.92 Median $26.92 Typical High $26.92 | Facility | None | $26.92 | $26.92 | $26.92 |
Geisinger Setting Professional Modifier None Typical Low $14.13 Median $16.22 Typical High $26.92 | Professional | None | $14.13 | $16.22 | $26.92 |
Highmark BCBS Setting Professional Modifier None Typical Low $18.62 Median $18.62 Typical High $18.62 | Professional | None | $18.62 | $18.62 | $18.62 |
Martin's Point Setting Facility Modifier None Typical Low $11.75 Median $11.75 Typical High $11.75 | Facility | None | $11.75 | $11.75 | $11.75 |
Martin's Point Setting Professional Modifier None Typical Low $11.75 Median $12.59 Typical High $12.88 | Professional | None | $11.75 | $12.59 | $12.88 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $5.89 Median $6.31 Typical High $6.46 | Professional | 52 · Reduced service | $5.89 | $6.31 | $6.46 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.34 Median $2.51 Typical High $2.63 | Professional | 53 · Discontinued | $2.34 | $2.51 | $2.63 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.78 Median $1.91 Typical High $1.95 | Professional | 55 · Aftercare only | $1.78 | $1.91 | $1.95 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.20 Median $1.26 Typical High $1.29 | Professional | 56 · Pre-op care only | $1.20 | $1.26 | $1.29 |
Oscar Health Setting Professional Modifier None Typical Low $19.50 Median $44.67 Typical High $46.77 | Professional | None | $19.50 | $44.67 | $46.77 |
UPMC Health Plan Setting Facility Modifier None Typical Low $12.59 Median $57.54 Typical High $100.00 | Facility | None | $12.59 | $57.54 | $100.00 |
UPMC Health Plan Setting Professional Modifier None Typical Low $12.59 Median $12.59 Typical High $25.12 | Professional | None | $12.59 | $12.59 | $25.12 |
United Setting Facility Modifier None Typical Low $14.45 Median $16.60 Typical High $43.65 | Facility | None | $14.45 | $16.60 | $43.65 |
United Setting Professional Modifier None Typical Low $12.02 Median $13.49 Typical High $21.88 | Professional | None | $12.02 | $13.49 | $21.88 |
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 |
|---|---|---|---|---|---|
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $23.99 Median $26.30 Typical High $26.30 | Professional | 50 · Both sides | $23.99 | $26.30 | $26.30 |
Where Pennsylvania sits
The same service costs 2.8 times more in Hawaii than in Pennsylvania. 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· 51st of 51
$13.49
HI $37.15PA $13.49
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.