How much rates vary
Facilitymedian $1,122 · 10th to 90th $372 to $5,495Professionalmedian $275 · 10th to 90th $204 to $490
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 $275.42 Median $1,047.13 Typical High $7,762.47 | Facility | None | $275.42 | $1,047.13 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $213.80 Median $275.42 Typical High $398.11 | Professional | None | $213.80 | $275.42 | $398.11 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $151.36 Median $190.55 Typical High $208.93 | Professional | 78 · Unplanned return to OR | $151.36 | $190.55 | $208.93 |
Ambetter Setting Professional Modifier None Typical Low $199.53 Median $316.23 Typical High $354.81 | Professional | None | $199.53 | $316.23 | $354.81 |
AmeriHealth Setting Facility Modifier None Typical Low $912.01 Median $3,090.30 Typical High $13,803.84 | Facility | None | $912.01 | $3,090.30 | $13,803.84 |
AmeriHealth Setting Professional Modifier None Typical Low $147.91 Median $147.91 Typical High $186.21 | Professional | None | $147.91 | $147.91 | $186.21 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $8,709.64 | Facility | None | $3,981.07 | $4,365.16 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $524.81 Median $741.31 Typical High $758.58 | Professional | None | $524.81 | $741.31 | $758.58 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $251.19 Median $263.03 Typical High $602.56 | Professional | 78 · Unplanned return to OR | $251.19 | $263.03 | $602.56 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $776.25 Typical High $1,445.44 | Facility | None | $478.63 | $776.25 | $1,445.44 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $257.04 Typical High $467.74 | Professional | None | $204.17 | $257.04 | $467.74 |
Emblem Health Setting Professional Modifier None Typical Low $575.44 Median $575.44 Typical High $575.44 | Professional | None | $575.44 | $575.44 | $575.44 |
Geisinger Setting Facility Modifier None Typical Low $724.44 Median $891.25 Typical High $1,584.89 | Facility | None | $724.44 | $891.25 | $1,584.89 |
Geisinger Setting Professional Modifier None Typical Low $229.09 Median $371.54 Typical High $562.34 | Professional | None | $229.09 | $371.54 | $562.34 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,445.44 Median $3,981.07 Typical High $7,079.46 | Facility | None | $1,445.44 | $3,981.07 | $7,079.46 |
Highmark BCBS Setting Professional Modifier None Typical Low $295.12 Median $316.23 Typical High $512.86 | Professional | None | $295.12 | $316.23 | $512.86 |
Independence Blue Cross Setting Facility Modifier None Typical Low $912.01 Median $3,162.28 Typical High $19,952.62 | Facility | None | $912.01 | $3,162.28 | $19,952.62 |
Independence Blue Cross Setting Professional Modifier None Typical Low $147.91 Median $147.91 Typical High $190.55 | Professional | None | $147.91 | $147.91 | $190.55 |
Martin's Point Setting Facility Modifier None Typical Low $275.42 Median $1,412.54 Typical High $7,762.47 | Facility | None | $275.42 | $1,412.54 | $7,762.47 |
Martin's Point Setting Professional Modifier None Typical Low $213.80 Median $275.42 Typical High $407.38 | Professional | None | $213.80 | $275.42 | $407.38 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $151.36 Median $190.55 Typical High $208.93 | Professional | 78 · Unplanned return to OR | $151.36 | $190.55 | $208.93 |
Oscar Health Setting Professional Modifier None Typical Low $263.03 Median $263.03 Typical High $562.34 | Professional | None | $263.03 | $263.03 | $562.34 |
UPMC Health Plan Setting Facility Modifier None Typical Low $213.80 Median $1,096.48 Typical High $2,511.89 | Facility | None | $213.80 | $1,096.48 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $213.80 Median $302.00 Typical High $309.03 | Professional | None | $213.80 | $302.00 | $309.03 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,630.78 | Facility | None | $416.87 | $724.44 | $3,630.78 |
United Setting Professional Modifier None Typical Low $218.78 Median $295.12 Typical High $512.86 | Professional | None | $218.78 | $295.12 | $512.86 |
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 $107.15 Median $134.90 Typical High $147.91 | Professional | 52 · Reduced service | $107.15 | $134.90 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $42.66 Median $53.70 Typical High $58.88 | Professional | 53 · Discontinued | $42.66 | $53.70 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $162.18 Median $204.17 Typical High $223.87 | Professional | 54 · Surgery only | $162.18 | $204.17 | $223.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $40.74 Typical High $44.67 | Professional | 55 · Aftercare only | $32.36 | $40.74 | $44.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.38 Median $26.92 Typical High $29.51 | Professional | 56 · Pre-op care only | $21.38 | $26.92 | $29.51 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $107.15 Median $138.04 Typical High $147.91 | Professional | 52 · Reduced service | $107.15 | $138.04 | $147.91 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $42.66 Median $54.95 Typical High $58.88 | Professional | 53 · Discontinued | $42.66 | $54.95 | $58.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $162.18 Median $204.17 Typical High $223.87 | Professional | 54 · Surgery only | $162.18 | $204.17 | $223.87 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $40.74 Typical High $44.67 | Professional | 55 · Aftercare only | $32.36 | $40.74 | $44.67 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $21.38 Median $27.54 Typical High $29.51 | Professional | 56 · Pre-op care only | $21.38 | $27.54 | $29.51 |
Where Pennsylvania sits
The same service costs 4.8 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· 45th of 51
$295
AK $1,202KY $251
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.