How much rates vary
Facilitymedian $251 · 10th to 90th $85 to $3,467Professionalmedian $170 · 10th to 90th $105 to $251
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 $138.04 Median $977.24 Typical High $6,165.95 | Facility | None | $138.04 | $977.24 | $6,165.95 |
Aetna Setting Professional Modifier None Typical Low $100.00 Median $169.82 Typical High $223.87 | Professional | None | $100.00 | $169.82 | $223.87 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $89.13 Typical High $134.90 | Professional | 78 · Unplanned return to OR | $69.18 | $89.13 | $134.90 |
AmeriHealth Setting Facility Modifier None Typical Low $691.83 Median $16,595.87 Typical High $36,307.81 | Facility | None | $691.83 | $16,595.87 | $36,307.81 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,511.89 Median $2,570.40 Typical High $56,234.13 | Facility | None | $2,511.89 | $2,570.40 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $158.49 | Professional | None | $158.49 | $158.49 | $158.49 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $144.54 Median $147.91 Typical High $354.81 | Professional | 78 · Unplanned return to OR | $144.54 | $147.91 | $354.81 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $141.25 Typical High $263.03 | Facility | None | $50.12 | $141.25 | $263.03 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $173.78 Typical High $257.04 | Professional | None | $104.71 | $173.78 | $257.04 |
Emblem Health Setting Professional Modifier None Typical Low $316.23 Median $316.23 Typical High $316.23 | Professional | None | $316.23 | $316.23 | $316.23 |
Geisinger Setting Facility Modifier None Typical Low $123.03 Median $154.88 Typical High $269.15 | Facility | None | $123.03 | $154.88 | $269.15 |
Geisinger Setting Professional Modifier None Typical Low $151.36 Median $229.09 Typical High $316.23 | Professional | None | $151.36 | $229.09 | $316.23 |
Highmark BCBS Setting Facility Modifier None Typical Low $218.78 Median $1,698.24 Typical High $3,235.94 | Facility | None | $218.78 | $1,698.24 | $3,235.94 |
Highmark BCBS Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
Independence Blue Cross Setting Facility Modifier None Typical Low $691.83 Median $724.44 Typical High $34,673.69 | Facility | None | $691.83 | $724.44 | $34,673.69 |
Martin's Point Setting Facility Modifier None Typical Low $154.88 Median $1,288.25 Typical High $6,025.60 | Facility | None | $154.88 | $1,288.25 | $6,025.60 |
Martin's Point Setting Professional Modifier None Typical Low $100.00 Median $169.82 Typical High $223.87 | Professional | None | $100.00 | $169.82 | $223.87 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $109.65 Typical High $134.90 | Professional | 78 · Unplanned return to OR | $69.18 | $109.65 | $134.90 |
Oscar Health Setting Professional Modifier None Typical Low $144.54 Median $144.54 Typical High $398.11 | Professional | None | $144.54 | $144.54 | $398.11 |
UPMC Health Plan Setting Facility Modifier None Typical Low $134.90 Median $812.83 Typical High $1,862.09 | Facility | None | $134.90 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $107.15 Median $177.83 Typical High $208.93 | Professional | None | $107.15 | $177.83 | $208.93 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,819.70 | Facility | None | $77.62 | $158.49 | $1,819.70 |
United Setting Professional Modifier None Typical Low $104.71 Median $173.78 Typical High $275.42 | Professional | None | $104.71 | $173.78 | $275.42 |
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 $50.12 Median $63.10 Typical High $95.50 | Professional | 52 · Reduced service | $50.12 | $63.10 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $25.12 Typical High $38.02 | Professional | 53 · Discontinued | $19.95 | $25.12 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $95.50 Typical High $144.54 | Professional | 54 · Surgery only | $74.13 | $95.50 | $144.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $21.38 Typical High $28.84 | Professional | 55 · Aftercare only | $14.79 | $21.38 | $28.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $14.13 Typical High $19.05 | Professional | 56 · Pre-op care only | $10.00 | $14.13 | $19.05 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $50.12 Median $79.43 Typical High $95.50 | Professional | 52 · Reduced service | $50.12 | $79.43 | $95.50 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $31.62 Typical High $38.02 | Professional | 53 · Discontinued | $19.95 | $31.62 | $38.02 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $117.49 Typical High $144.54 | Professional | 54 · Surgery only | $74.13 | $117.49 | $144.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $23.44 Typical High $28.84 | Professional | 55 · Aftercare only | $14.79 | $23.44 | $28.84 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $15.85 Typical High $19.05 | Professional | 56 · Pre-op care only | $10.00 | $15.85 | $19.05 |
Where Pennsylvania sits
The same service costs 3.5 times more in Alaska than in Florida. 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· 40th of 51
$174
AK $490FL $138
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.