How much rates vary
Facilitymedian $575 · 10th to 90th $170 to $7,244Professionalmedian $158 · 10th to 90th $91 to $316
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 $131.83 Median $1,548.82 Typical High $6,165.95 | Facility | None | $131.83 | $1,548.82 | $6,165.95 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $162.18 Typical High $281.84 | Professional | None | $91.20 | $162.18 | $281.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $89.13 Typical High $169.82 | Professional | 78 · Unplanned return to OR | $63.10 | $89.13 | $169.82 |
Ambetter Setting Professional Modifier None Typical Low $489.78 Median $489.78 Typical High $489.78 | Professional | None | $489.78 | $489.78 | $489.78 |
AmeriHealth Setting Facility Modifier None Typical Low $707.95 Median $10,000.00 Typical High $15,848.93 | Facility | None | $707.95 | $10,000.00 | $15,848.93 |
Capital Blue Cross Setting Facility Modifier None Typical Low $1,202.26 Median $1,258.93 Typical High $8,709.64 | Facility | None | $1,202.26 | $1,258.93 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $380.19 Median $380.19 Typical High $380.19 | Professional | None | $380.19 | $380.19 | $380.19 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $190.55 Median $194.98 Typical High $331.13 | Professional | 78 · Unplanned return to OR | $190.55 | $194.98 | $331.13 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $245.47 Typical High $436.52 | Facility | None | $50.12 | $245.47 | $436.52 |
Cigna Setting Professional Modifier None Typical Low $87.10 Median $158.49 Typical High $302.00 | Professional | None | $87.10 | $158.49 | $302.00 |
Emblem Health Setting Professional Modifier None Typical Low $467.74 Median $467.74 Typical High $467.74 | Professional | None | $467.74 | $467.74 | $467.74 |
Geisinger Setting Facility Modifier None Typical Low $218.78 Median $269.15 Typical High $478.63 | Facility | None | $218.78 | $269.15 | $478.63 |
Geisinger Setting Professional Modifier None Typical Low $117.49 Median $275.42 Typical High $436.52 | Professional | None | $117.49 | $275.42 | $436.52 |
Highmark BCBS Setting Facility Modifier None Typical Low $446.68 Median $1,348.96 Typical High $2,630.27 | Facility | None | $446.68 | $1,348.96 | $2,630.27 |
Highmark BCBS Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $257.04 | Professional | None | $245.47 | $245.47 | $257.04 |
Independence Blue Cross Setting Facility Modifier None Typical Low $724.44 Median $7,413.10 Typical High $15,488.17 | Facility | None | $724.44 | $7,413.10 | $15,488.17 |
Martin's Point Setting Facility Modifier None Typical Low $131.83 Median $1,513.56 Typical High $5,888.44 | Facility | None | $131.83 | $1,513.56 | $5,888.44 |
Martin's Point Setting Professional Modifier None Typical Low $91.20 Median $169.82 Typical High $269.15 | Professional | None | $91.20 | $169.82 | $269.15 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $89.13 Typical High $169.82 | Professional | 78 · Unplanned return to OR | $63.10 | $89.13 | $169.82 |
Oscar Health Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $323.59 | Professional | None | $128.82 | $128.82 | $323.59 |
UPMC Health Plan Setting Facility Modifier None Typical Low $89.13 Median $239.88 Typical High $457.09 | Facility | None | $89.13 | $239.88 | $457.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $89.13 Median $147.91 Typical High $239.88 | Professional | None | $89.13 | $147.91 | $239.88 |
United Setting Facility Modifier None Typical Low $199.53 Median $436.52 Typical High $2,089.30 | Facility | None | $199.53 | $436.52 | $2,089.30 |
United Setting Professional Modifier None Typical Low $93.33 Median $173.78 Typical High $316.23 | Professional | None | $93.33 | $173.78 | $316.23 |
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 $44.67 Median $64.57 Typical High $120.23 | Professional | 52 · Reduced service | $44.67 | $64.57 | $120.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $25.70 Typical High $47.86 | Professional | 53 · Discontinued | $18.20 | $25.70 | $47.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $95.50 Typical High $181.97 | Professional | 54 · Surgery only | $67.61 | $95.50 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $19.05 Typical High $36.31 | Professional | 55 · Aftercare only | $13.49 | $19.05 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $12.88 Typical High $23.99 | Professional | 56 · Pre-op care only | $9.12 | $12.88 | $23.99 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $44.67 Median $64.57 Typical High $120.23 | Professional | 52 · Reduced service | $44.67 | $64.57 | $120.23 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $25.70 Typical High $47.86 | Professional | 53 · Discontinued | $18.20 | $25.70 | $47.86 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $95.50 Typical High $181.97 | Professional | 54 · Surgery only | $67.61 | $95.50 | $181.97 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $19.05 Typical High $36.31 | Professional | 55 · Aftercare only | $13.49 | $19.05 | $36.31 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $12.88 Typical High $23.99 | Professional | 56 · Pre-op care only | $9.12 | $12.88 | $23.99 |
Where Pennsylvania sits
The same service costs 4.1 times more in Alaska than in Kentucky. 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· 25th of 51
$209
AK $501KY $123
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.