How much rates vary
Facilitymedian $1,514 · 10th to 90th $537 to $5,495Professionalmedian $339 · 10th to 90th $275 to $575
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 $354.81 Median $2,630.27 Typical High $8,511.38 | Facility | None | $354.81 | $2,630.27 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $275.42 Median $338.84 Typical High $467.74 | Professional | None | $275.42 | $338.84 | $467.74 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $194.98 Median $234.42 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $194.98 | $234.42 | $251.19 |
Ambetter Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $269.15 | Professional | None | $269.15 | $269.15 | $269.15 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $6,025.60 Typical High $8,709.64 | Facility | None | $3,981.07 | $6,025.60 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $56,234.13 Median $56,234.13 Typical High $56,234.13 | Professional | None | $56,234.13 | $56,234.13 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $309.03 Median $316.23 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $309.03 | $316.23 | $741.31 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $1,202.26 Typical High $2,041.74 | Facility | None | $478.63 | $1,202.26 | $2,041.74 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $338.84 Typical High $602.56 | Professional | None | $281.84 | $338.84 | $602.56 |
Emblem Health Setting Professional Modifier None Typical Low $676.08 Median $676.08 Typical High $676.08 | Professional | None | $676.08 | $676.08 | $676.08 |
Geisinger Setting Facility Modifier None Typical Low $1,202.26 Median $1,513.56 Typical High $2,630.27 | Facility | None | $1,202.26 | $1,513.56 | $2,630.27 |
Geisinger Setting Professional Modifier None Typical Low $331.13 Median $478.63 Typical High $676.08 | Professional | None | $331.13 | $478.63 | $676.08 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,412.54 Median $6,456.54 Typical High $14,791.08 | Facility | None | $1,412.54 | $6,456.54 | $14,791.08 |
Highmark BCBS Setting Professional Modifier None Typical Low $389.05 Median $398.11 Typical High $645.65 | Professional | None | $389.05 | $398.11 | $645.65 |
Martin's Point Setting Facility Modifier None Typical Low $537.03 Median $2,570.40 Typical High $8,317.64 | Facility | None | $537.03 | $2,570.40 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $275.42 Median $338.84 Typical High $467.74 | Professional | None | $275.42 | $338.84 | $467.74 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $194.98 Median $234.42 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $194.98 | $234.42 | $251.19 |
Oscar Health Setting Professional Modifier None Typical Low $371.54 Median $371.54 Typical High $724.44 | Professional | None | $371.54 | $371.54 | $724.44 |
UPMC Health Plan Setting Facility Modifier None Typical Low $295.12 Median $1,096.48 Typical High $2,511.89 | Facility | None | $295.12 | $1,096.48 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $295.12 Median $363.08 Typical High $371.54 | Professional | None | $295.12 | $363.08 | $371.54 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,265.80 | Facility | None | $812.83 | $1,318.26 | $4,265.80 |
United Setting Professional Modifier None Typical Low $295.12 Median $363.08 Typical High $645.65 | Professional | None | $295.12 | $363.08 | $645.65 |
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 $138.04 Median $165.96 Typical High $177.83 | Professional | 52 · Reduced service | $138.04 | $165.96 | $177.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $54.95 Median $66.07 Typical High $70.79 | Professional | 53 · Discontinued | $54.95 | $66.07 | $70.79 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $245.47 Typical High $269.15 | Professional | 54 · Surgery only | $208.93 | $245.47 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $50.12 Typical High $53.70 | Professional | 55 · Aftercare only | $41.69 | $50.12 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $27.54 Median $33.11 Typical High $35.48 | Professional | 56 · Pre-op care only | $27.54 | $33.11 | $35.48 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $138.04 Median $169.82 Typical High $177.83 | Professional | 52 · Reduced service | $138.04 | $169.82 | $177.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $54.95 Median $67.61 Typical High $70.79 | Professional | 53 · Discontinued | $54.95 | $67.61 | $70.79 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $251.19 Typical High $269.15 | Professional | 54 · Surgery only | $208.93 | $251.19 | $269.15 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $50.12 Typical High $53.70 | Professional | 55 · Aftercare only | $41.69 | $50.12 | $53.70 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $27.54 Median $33.88 Typical High $35.48 | Professional | 56 · Pre-op care only | $27.54 | $33.88 | $35.48 |
Where Pennsylvania sits
The same service costs 4.5 times more in Alaska than in New Jersey. 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· 48th of 51
$355
AK $1,549NJ $347
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.