How much rates vary
Facilitymedian $389 · 10th to 90th $178 to $4,074Professionalmedian $257 · 10th to 90th $178 to $398
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 $213.80 Median $1,047.13 Typical High $6,165.95 | Facility | None | $213.80 | $1,047.13 | $6,165.95 |
Aetna Setting Professional Modifier None Typical Low $181.97 Median $257.04 Typical High $354.81 | Professional | None | $181.97 | $257.04 | $354.81 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $165.96 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $125.89 | $165.96 | $190.55 |
AmeriHealth Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $147.91 | Professional | None | $138.04 | $138.04 | $147.91 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $56,234.13 | Facility | None | $3,981.07 | $4,365.16 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $501.19 Median $501.19 Typical High $56,234.13 | Professional | None | $501.19 | $501.19 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $234.42 Median $239.88 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $234.42 | $239.88 | $575.44 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $223.87 Typical High $501.19 | Facility | None | $50.12 | $223.87 | $501.19 |
Cigna Setting Professional Modifier None Typical Low $177.83 Median $257.04 Typical High $407.38 | Professional | None | $177.83 | $257.04 | $407.38 |
Emblem Health Setting Professional Modifier None Typical Low $501.19 Median $501.19 Typical High $501.19 | Professional | None | $501.19 | $501.19 | $501.19 |
Geisinger Setting Facility Modifier None Typical Low $177.83 Median $218.78 Typical High $389.05 | Facility | None | $177.83 | $218.78 | $389.05 |
Geisinger Setting Professional Modifier None Typical Low $218.78 Median $346.74 Typical High $489.78 | Professional | None | $218.78 | $346.74 | $489.78 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,290.87 Median $4,168.69 Typical High $8,709.64 | Facility | None | $2,290.87 | $4,168.69 | $8,709.64 |
Highmark BCBS Setting Professional Modifier None Typical Low $269.15 Median $295.12 Typical High $398.11 | Professional | None | $269.15 | $295.12 | $398.11 |
Independence Blue Cross Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $138.04 | Professional | None | $138.04 | $138.04 | $138.04 |
Martin's Point Setting Facility Modifier None Typical Low $257.04 Median $1,513.56 Typical High $6,025.60 | Facility | None | $257.04 | $1,513.56 | $6,025.60 |
Martin's Point Setting Professional Modifier None Typical Low $181.97 Median $257.04 Typical High $354.81 | Professional | None | $181.97 | $257.04 | $354.81 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $165.96 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $125.89 | $165.96 | $190.55 |
Oscar Health Setting Professional Modifier None Typical Low $263.03 Median $263.03 Typical High $575.44 | Professional | None | $263.03 | $263.03 | $575.44 |
UPMC Health Plan Setting Facility Modifier None Typical Low $204.17 Median $1,071.52 Typical High $2,511.89 | Facility | None | $204.17 | $1,071.52 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $204.17 Median $263.03 Typical High $288.40 | Professional | None | $204.17 | $263.03 | $288.40 |
United Setting Facility Modifier None Typical Low $199.53 Median $436.52 Typical High $3,467.37 | Facility | None | $199.53 | $436.52 | $3,467.37 |
United Setting Professional Modifier None Typical Low $190.55 Median $275.42 Typical High $457.09 | Professional | None | $190.55 | $275.42 | $457.09 |
11 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 $89.13 Median $120.23 Typical High $134.90 | Professional | 52 · Reduced service | $89.13 | $120.23 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $36.31 Median $47.86 Typical High $54.95 | Professional | 53 · Discontinued | $36.31 | $47.86 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $177.83 Typical High $204.17 | Professional | 54 · Surgery only | $134.90 | $177.83 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $35.48 Typical High $40.74 | Professional | 55 · Aftercare only | $26.92 | $35.48 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $23.99 Typical High $27.54 | Professional | 56 · Pre-op care only | $17.78 | $23.99 | $27.54 |
Ambetter Setting Professional Modifier 51 · Multiple procedures Typical Low $186.21 Median $186.21 Typical High $186.21 | Professional | 51 · Multiple procedures | $186.21 | $186.21 | $186.21 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $89.13 Median $120.23 Typical High $134.90 | Professional | 52 · Reduced service | $89.13 | $120.23 | $134.90 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $36.31 Median $47.86 Typical High $54.95 | Professional | 53 · Discontinued | $36.31 | $47.86 | $54.95 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $177.83 Typical High $204.17 | Professional | 54 · Surgery only | $134.90 | $177.83 | $204.17 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $35.48 Typical High $40.74 | Professional | 55 · Aftercare only | $26.92 | $35.48 | $40.74 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $17.78 Median $23.99 Typical High $27.54 | Professional | 56 · Pre-op care only | $17.78 | $23.99 | $27.54 |
Where Pennsylvania sits
The same service costs 3.9 times more in Alaska than in Texas. 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· 44th of 51
$257
AK $851TX $219
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.