How much rates vary
Facilitymedian $380 · 10th to 90th $95 to $2,570Professionalmedian $155 · 10th to 90th $93 to $240
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 $758.58 Typical High $6,165.95 | Facility | None | $114.82 | $758.58 | $6,165.95 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $144.54 Typical High $229.09 | Professional | None | $91.20 | $144.54 | $229.09 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $100.00 Typical High $112.20 | Professional | 78 · Unplanned return to OR | $63.10 | $100.00 | $112.20 |
Ambetter Setting Professional Modifier None Typical Low $147.91 Median $147.91 Typical High $181.97 | Professional | None | $147.91 | $147.91 | $181.97 |
AmeriHealth Setting Facility Modifier None Typical Low $52.48 Median $707.95 Typical High $13,182.57 | Facility | None | $52.48 | $707.95 | $13,182.57 |
AmeriHealth Setting Professional Modifier None Typical Low $75.86 Median $151.36 Typical High $263.03 | Professional | None | $75.86 | $151.36 | $263.03 |
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 $154.88 Median $162.18 Typical High $371.54 | Professional | None | $154.88 | $162.18 | $371.54 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $128.82 Typical High $295.12 | Professional | 78 · Unplanned return to OR | $125.89 | $128.82 | $295.12 |
Cigna Setting Facility Modifier None Typical Low $109.65 Median $302.00 Typical High $549.54 | Facility | None | $109.65 | $302.00 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $158.49 Typical High $257.04 | Professional | None | $97.72 | $158.49 | $257.04 |
Emblem Health Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $269.15 | Professional | None | $269.15 | $269.15 | $269.15 |
Geisinger Setting Facility Modifier None Typical Low $100.00 Median $123.03 Typical High $218.78 | Facility | None | $100.00 | $123.03 | $218.78 |
Geisinger Setting Professional Modifier None Typical Low $147.91 Median $208.93 Typical High $323.59 | Professional | None | $147.91 | $208.93 | $323.59 |
Highmark BCBS Setting Facility Modifier None Typical Low $85.11 Median $812.83 Typical High $1,621.81 | Facility | None | $85.11 | $812.83 | $1,621.81 |
Independence Blue Cross Setting Facility Modifier None Typical Low $60.26 Median $676.08 Typical High $7,413.10 | Facility | None | $60.26 | $676.08 | $7,413.10 |
Independence Blue Cross Setting Professional Modifier None Typical Low $75.86 Median $151.36 Typical High $151.36 | Professional | None | $75.86 | $151.36 | $151.36 |
Martin's Point Setting Facility Modifier None Typical Low $125.89 Median $977.24 Typical High $5,888.44 | Facility | None | $125.89 | $977.24 | $5,888.44 |
Martin's Point Setting Professional Modifier None Typical Low $91.20 Median $144.54 Typical High $239.88 | Professional | None | $91.20 | $144.54 | $239.88 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $100.00 Typical High $112.20 | Professional | 78 · Unplanned return to OR | $63.10 | $100.00 | $112.20 |
Oscar Health Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $416.87 | Professional | None | $165.96 | $165.96 | $416.87 |
UPMC Health Plan Setting Facility Modifier None Typical Low $154.88 Median $489.78 Typical High $1,122.02 | Facility | None | $154.88 | $489.78 | $1,122.02 |
UPMC Health Plan Setting Professional Modifier None Typical Low $97.72 Median $154.88 Typical High $194.98 | Professional | None | $97.72 | $154.88 | $194.98 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,348.96 | Facility | None | $77.62 | $158.49 | $1,348.96 |
United Setting Professional Modifier None Typical Low $93.33 Median $144.54 Typical High $245.47 | Professional | None | $93.33 | $144.54 | $245.47 |
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 $45.71 Median $70.79 Typical High $81.28 | Professional | 52 · Reduced service | $45.71 | $70.79 | $81.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $28.18 Typical High $32.36 | Professional | 53 · Discontinued | $18.20 | $28.18 | $32.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $107.15 Typical High $120.23 | Professional | 54 · Surgery only | $67.61 | $107.15 | $120.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $21.38 Typical High $23.99 | Professional | 55 · Aftercare only | $13.49 | $21.38 | $23.99 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $14.13 Typical High $16.22 | Professional | 56 · Pre-op care only | $9.12 | $14.13 | $16.22 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $45.71 Median $72.44 Typical High $81.28 | Professional | 52 · Reduced service | $45.71 | $72.44 | $81.28 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $28.84 Typical High $32.36 | Professional | 53 · Discontinued | $18.20 | $28.84 | $32.36 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $107.15 Typical High $120.23 | Professional | 54 · Surgery only | $67.61 | $107.15 | $120.23 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $21.38 Typical High $23.99 | Professional | 55 · Aftercare only | $13.49 | $21.38 | $23.99 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $14.45 Typical High $16.22 | Professional | 56 · Pre-op care only | $9.12 | $14.45 | $16.22 |
Where Pennsylvania sits
The same service costs 3.2 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· 42nd of 51
$158
AK $427TX $132
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.