How much rates vary
Facilitymedian $324 · 10th to 90th $87 to $2,692Professionalmedian $234 · 10th to 90th $145 to $355
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 $204.17 Median $602.56 Typical High $6,025.60 | Facility | None | $204.17 | $602.56 | $6,025.60 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $245.47 Typical High $338.84 | Professional | None | $144.54 | $245.47 | $338.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $102.33 Median $141.25 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $102.33 | $141.25 | $186.21 |
Ambetter Setting Professional Modifier None Typical Low $144.54 Median $144.54 Typical High $346.74 | Professional | None | $144.54 | $144.54 | $346.74 |
AmeriHealth Setting Facility Modifier None Typical Low $10,715.19 Median $10,715.19 Typical High $10,715.19 | Facility | None | $10,715.19 | $10,715.19 | $10,715.19 |
AmeriHealth Setting Professional Modifier None Typical Low $131.83 Median $131.83 Typical High $141.25 | Professional | None | $131.83 | $131.83 | $141.25 |
Capital Blue Cross Setting Facility Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $56,234.13 | Facility | None | $1,202.26 | $1,412.54 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $302.00 Median $302.00 Typical High $56,234.13 | Professional | None | $302.00 | $302.00 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $218.78 Median $229.09 Typical High $489.78 | Professional | 78 · Unplanned return to OR | $218.78 | $229.09 | $489.78 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $218.78 Typical High $407.38 | Facility | None | $50.12 | $218.78 | $407.38 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $234.42 Typical High $371.54 | Professional | None | $158.49 | $234.42 | $371.54 |
Emblem Health Setting Professional Modifier None Typical Low $478.63 Median $478.63 Typical High $478.63 | Professional | None | $478.63 | $478.63 | $478.63 |
Geisinger Setting Facility Modifier None Typical Low $190.55 Median $239.88 Typical High $426.58 | Facility | None | $190.55 | $239.88 | $426.58 |
Geisinger Setting Professional Modifier None Typical Low $199.53 Median $316.23 Typical High $467.74 | Professional | None | $199.53 | $316.23 | $467.74 |
Highmark BCBS Setting Facility Modifier None Typical Low $323.59 Median $776.25 Typical High $1,698.24 | Facility | None | $323.59 | $776.25 | $1,698.24 |
Highmark BCBS Setting Professional Modifier None Typical Low $194.98 Median $269.15 Typical High $323.59 | Professional | None | $194.98 | $269.15 | $323.59 |
Independence Blue Cross Setting Facility Modifier None Typical Low $758.58 Median $10,000.00 Typical High $20,892.96 | Facility | None | $758.58 | $10,000.00 | $20,892.96 |
Independence Blue Cross Setting Professional Modifier None Typical Low $131.83 Median $131.83 Typical High $141.25 | Professional | None | $131.83 | $131.83 | $141.25 |
Martin's Point Setting Facility Modifier None Typical Low $218.78 Median $724.44 Typical High $5,754.40 | Facility | None | $218.78 | $724.44 | $5,754.40 |
Martin's Point Setting Professional Modifier None Typical Low $144.54 Median $245.47 Typical High $346.74 | Professional | None | $144.54 | $245.47 | $346.74 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $102.33 Median $144.54 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $102.33 | $144.54 | $186.21 |
Oscar Health Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $524.81 | Professional | None | $229.09 | $229.09 | $524.81 |
UPMC Health Plan Setting Facility Modifier None Typical Low $165.96 Median $263.03 Typical High $436.52 | Facility | None | $165.96 | $263.03 | $436.52 |
UPMC Health Plan Setting Professional Modifier None Typical Low $165.96 Median $245.47 Typical High $275.42 | Professional | None | $165.96 | $245.47 | $275.42 |
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 $151.36 Median $239.88 Typical High $389.05 | Professional | None | $151.36 | $239.88 | $389.05 |
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 $72.44 Median $100.00 Typical High $131.83 | Professional | 52 · Reduced service | $72.44 | $100.00 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $39.81 Typical High $52.48 | Professional | 53 · Discontinued | $28.84 | $39.81 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $151.36 Typical High $199.53 | Professional | 54 · Surgery only | $109.65 | $151.36 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $30.20 Typical High $39.81 | Professional | 55 · Aftercare only | $21.88 | $30.20 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $19.95 Typical High $26.30 | Professional | 56 · Pre-op care only | $14.45 | $19.95 | $26.30 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $72.44 Median $102.33 Typical High $131.83 | Professional | 52 · Reduced service | $72.44 | $102.33 | $131.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $41.69 Typical High $52.48 | Professional | 53 · Discontinued | $28.84 | $41.69 | $52.48 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $154.88 Typical High $199.53 | Professional | 54 · Surgery only | $109.65 | $154.88 | $199.53 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $30.90 Typical High $39.81 | Professional | 55 · Aftercare only | $21.88 | $30.90 | $39.81 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $20.42 Typical High $26.30 | Professional | 56 · Pre-op care only | $14.45 | $20.42 | $26.30 |
Where Pennsylvania sits
The same service costs 3.4 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· 39th of 51
$245
AK $692KY $204
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.