How much rates vary
Facilitymedian $21 · 10th to 90th $4 to $5,012Professionalmedian $5 · 10th to 90th $3 to $8
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 $3.98 Median $3.98 Typical High $5.01 | Facility | None | $3.98 | $3.98 | $5.01 |
Aetna Setting Professional Modifier None Typical Low $3.98 Median $5.01 Typical High $5.50 | Professional | None | $3.98 | $5.01 | $5.50 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $2.00 Median $2.45 Typical High $2.51 | Professional | 52 · Reduced service | $2.00 | $2.45 | $2.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.79 Median $1.00 Typical High $1.00 | Professional | 53 · Discontinued | $0.79 | $1.00 | $1.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2.95 Median $3.72 Typical High $3.72 | Professional | 54 · Surgery only | $2.95 | $3.72 | $3.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.59 Median $0.74 Typical High $0.74 | Professional | 55 · Aftercare only | $0.59 | $0.74 | $0.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.40 Median $0.50 Typical High $0.50 | Professional | 56 · Pre-op care only | $0.40 | $0.50 | $0.50 |
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 $7.24 Median $8.13 Typical High $8.13 | Professional | None | $7.24 | $8.13 | $8.13 |
Cigna Setting Professional Modifier None Typical Low $3.39 Median $3.39 Typical High $3.39 | Professional | None | $3.39 | $3.39 | $3.39 |
Emblem Health Setting Professional Modifier None Typical Low $10.72 Median $12.02 Typical High $15.14 | Professional | None | $10.72 | $12.02 | $15.14 |
Geisinger Setting Facility Modifier None Typical Low $8.32 Median $8.32 Typical High $8.32 | Facility | None | $8.32 | $8.32 | $8.32 |
Geisinger Setting Professional Modifier None Typical Low $4.90 Median $5.37 Typical High $9.55 | Professional | None | $4.90 | $5.37 | $9.55 |
Martin's Point Setting Facility Modifier None Typical Low $3.98 Median $3.98 Typical High $3.98 | Facility | None | $3.98 | $3.98 | $3.98 |
Martin's Point Setting Professional Modifier None Typical Low $3.98 Median $5.01 Typical High $5.13 | Professional | None | $3.98 | $5.01 | $5.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2.00 Median $2.45 Typical High $2.45 | Professional | 52 · Reduced service | $2.00 | $2.45 | $2.45 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.79 Median $1.00 Typical High $1.00 | Professional | 53 · Discontinued | $0.79 | $1.00 | $1.00 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2.95 Median $3.72 Typical High $3.72 | Professional | 54 · Surgery only | $2.95 | $3.72 | $3.72 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.59 Median $0.74 Typical High $0.74 | Professional | 55 · Aftercare only | $0.59 | $0.74 | $0.74 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.40 Median $0.50 Typical High $0.50 | Professional | 56 · Pre-op care only | $0.40 | $0.50 | $0.50 |
Oscar Health Setting Professional Modifier None Typical Low $3.89 Median $3.89 Typical High $26.92 | Professional | None | $3.89 | $3.89 | $26.92 |
UPMC Health Plan Setting Facility Modifier None Typical Low $4.79 Median $21.38 Typical High $37.15 | Facility | None | $4.79 | $21.38 | $37.15 |
UPMC Health Plan Setting Professional Modifier None Typical Low $4.79 Median $4.79 Typical High $7.76 | Professional | None | $4.79 | $4.79 | $7.76 |
United Setting Professional Modifier None Typical Low $3.47 Median $4.07 Typical High $5.62 | Professional | None | $3.47 | $4.07 | $5.62 |
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 Facility Modifier PN · Off-campus dept, non-excepted Typical Low $63.10 Median $63.10 Typical High $63.10 | Facility | PN · Off-campus dept, non-excepted | $63.10 | $63.10 | $63.10 |
Where Pennsylvania sits
The same service costs 3.2 times more in Rhode Island than in New York. 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· 28th of 51
$5.01
RI $10.72NY $3.31
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.