How much rates vary
Facilitymedian $380 · 10th to 90th $107 to $3,715Professionalmedian $123 · 10th to 90th $89 to $200
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 $114.82 Median $1,023.29 Typical High $7,244.36 | Facility | None | $114.82 | $1,023.29 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $123.03 Typical High $173.78 | Professional | None | $89.13 | $123.03 | $173.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $81.28 Typical High $93.33 | Professional | 78 · Unplanned return to OR | $63.10 | $81.28 | $93.33 |
Ambetter Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $120.23 | Professional | None | $120.23 | $120.23 | $120.23 |
AmeriHealth Setting Professional Modifier None Typical Low $134.90 Median $134.90 Typical High $141.25 | Professional | None | $134.90 | $134.90 | $141.25 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,454.71 Median $2,570.40 Typical High $8,709.64 | Facility | None | $2,454.71 | $2,570.40 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $223.87 Median $257.04 Typical High $257.04 | Professional | None | $223.87 | $257.04 | $257.04 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $109.65 Median $114.82 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $109.65 | $114.82 | $251.19 |
Cigna Setting Facility Modifier None Typical Low $112.20 Median $288.40 Typical High $549.54 | Facility | None | $112.20 | $288.40 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $89.13 Median $120.23 Typical High $208.93 | Professional | None | $89.13 | $120.23 | $208.93 |
Emblem Health Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | None | $239.88 | $239.88 | $239.88 |
Geisinger Setting Facility Modifier None Typical Low $102.33 Median $125.89 Typical High $223.87 | Facility | None | $102.33 | $125.89 | $223.87 |
Geisinger Setting Professional Modifier None Typical Low $114.82 Median $165.96 Typical High $239.88 | Professional | None | $114.82 | $165.96 | $239.88 |
Highmark BCBS Setting Facility Modifier None Typical Low $169.82 Median $1,548.82 Typical High $4,073.80 | Facility | None | $169.82 | $1,548.82 | $4,073.80 |
Highmark BCBS Setting Professional Modifier None Typical Low $125.89 Median $141.25 Typical High $162.18 | Professional | None | $125.89 | $141.25 | $162.18 |
Independence Blue Cross Setting Professional Modifier None Typical Low $134.90 Median $134.90 Typical High $141.25 | Professional | None | $134.90 | $134.90 | $141.25 |
Martin's Point Setting Facility Modifier None Typical Low $123.03 Median $1,479.11 Typical High $6,606.93 | Facility | None | $123.03 | $1,479.11 | $6,606.93 |
Martin's Point Setting Professional Modifier None Typical Low $89.13 Median $123.03 Typical High $173.78 | Professional | None | $89.13 | $123.03 | $173.78 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $81.28 Typical High $93.33 | Professional | 78 · Unplanned return to OR | $63.10 | $81.28 | $93.33 |
Oscar Health Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $251.19 | Professional | None | $151.36 | $151.36 | $251.19 |
UPMC Health Plan Setting Facility Modifier None Typical Low $93.33 Median $812.83 Typical High $1,862.09 | Facility | None | $93.33 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $93.33 Median $123.03 Typical High $138.04 | Professional | None | $93.33 | $123.03 | $138.04 |
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 $91.20 Median $128.82 Typical High $218.78 | Professional | None | $91.20 | $128.82 | $218.78 |
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 $57.54 Typical High $66.07 | Professional | 52 · Reduced service | $44.67 | $57.54 | $66.07 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $22.91 Typical High $26.92 | Professional | 53 · Discontinued | $18.20 | $22.91 | $26.92 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $87.10 Typical High $100.00 | Professional | 54 · Surgery only | $67.61 | $87.10 | $100.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $17.38 Typical High $19.95 | Professional | 55 · Aftercare only | $13.49 | $17.38 | $19.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $11.48 Typical High $13.18 | Professional | 56 · Pre-op care only | $8.91 | $11.48 | $13.18 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $44.67 Median $57.54 Typical High $66.07 | Professional | 52 · Reduced service | $44.67 | $57.54 | $66.07 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $23.44 Typical High $26.92 | Professional | 53 · Discontinued | $18.20 | $23.44 | $26.92 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $87.10 Typical High $100.00 | Professional | 54 · Surgery only | $67.61 | $87.10 | $100.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $17.38 Typical High $19.95 | Professional | 55 · Aftercare only | $13.49 | $17.38 | $19.95 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $11.48 Typical High $13.18 | Professional | 56 · Pre-op care only | $8.91 | $11.48 | $13.18 |
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· 42nd of 51
$132
AK $437KY $107
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.