How much rates vary
Facilitymedian $427 · 10th to 90th $95 to $6,310Professionalmedian $257 · 10th to 90th $170 to $407
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 $239.88 Median $660.69 Typical High $6,025.60 | Facility | None | $239.88 | $660.69 | $6,025.60 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $275.42 Typical High $380.19 | Professional | None | $169.82 | $275.42 | $380.19 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $162.18 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $120.23 | $162.18 | $204.17 |
Ambetter Setting Professional Modifier None Typical Low $144.54 Median $181.97 Typical High $398.11 | Professional | None | $144.54 | $181.97 | $398.11 |
AmeriHealth Setting Facility Modifier None Typical Low $2,951.21 Median $12,022.64 Typical High $17,782.79 | Facility | None | $2,951.21 | $12,022.64 | $17,782.79 |
AmeriHealth Setting Professional Modifier None Typical Low $147.91 Median $147.91 Typical High $154.88 | Professional | None | $147.91 | $147.91 | $154.88 |
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 $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 $245.47 Median $257.04 Typical High $549.54 | Professional | 78 · Unplanned return to OR | $245.47 | $257.04 | $549.54 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $229.09 Typical High $416.87 | Facility | None | $50.12 | $229.09 | $416.87 |
Cigna Setting Professional Modifier None Typical Low $177.83 Median $257.04 Typical High $426.58 | Professional | None | $177.83 | $257.04 | $426.58 |
Emblem Health Setting Professional Modifier None Typical Low $537.03 Median $537.03 Typical High $537.03 | Professional | None | $537.03 | $537.03 | $537.03 |
Geisinger Setting Facility Modifier None Typical Low $204.17 Median $251.19 Typical High $446.68 | Facility | None | $204.17 | $251.19 | $446.68 |
Geisinger Setting Professional Modifier None Typical Low $218.78 Median $346.74 Typical High $512.86 | Professional | None | $218.78 | $346.74 | $512.86 |
Highmark BCBS Setting Facility Modifier None Typical Low $275.42 Median $851.14 Typical High $1,548.82 | Facility | None | $275.42 | $851.14 | $1,548.82 |
Highmark BCBS Setting Professional Modifier None Typical Low $199.53 Median $302.00 Typical High $363.08 | Professional | None | $199.53 | $302.00 | $363.08 |
Independence Blue Cross Setting Facility Modifier None Typical Low $602.56 Median $8,128.31 Typical High $17,782.79 | Facility | None | $602.56 | $8,128.31 | $17,782.79 |
Independence Blue Cross Setting Professional Modifier None Typical Low $147.91 Median $147.91 Typical High $147.91 | Professional | None | $147.91 | $147.91 | $147.91 |
Martin's Point Setting Facility Modifier None Typical Low $257.04 Median $812.83 Typical High $5,754.40 | Facility | None | $257.04 | $812.83 | $5,754.40 |
Martin's Point Setting Professional Modifier None Typical Low $169.82 Median $275.42 Typical High $380.19 | Professional | None | $169.82 | $275.42 | $380.19 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $162.18 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $120.23 | $162.18 | $204.17 |
Oscar Health Setting Professional Modifier None Typical Low $251.19 Median $251.19 Typical High $588.84 | Professional | None | $251.19 | $251.19 | $588.84 |
UPMC Health Plan Setting Facility Modifier None Typical Low $194.98 Median $269.15 Typical High $436.52 | Facility | None | $194.98 | $269.15 | $436.52 |
UPMC Health Plan Setting Professional Modifier None Typical Low $194.98 Median $269.15 Typical High $309.03 | Professional | None | $194.98 | $269.15 | $309.03 |
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 $181.97 Median $269.15 Typical High $436.52 | Professional | None | $181.97 | $269.15 | $436.52 |
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 $85.11 Median $117.49 Typical High $147.91 | Professional | 52 · Reduced service | $85.11 | $117.49 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $46.77 Typical High $58.88 | Professional | 53 · Discontinued | $33.88 | $46.77 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $173.78 Typical High $218.78 | Professional | 54 · Surgery only | $128.82 | $173.78 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $34.67 Typical High $43.65 | Professional | 55 · Aftercare only | $25.70 | $34.67 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $23.44 Typical High $29.51 | Professional | 56 · Pre-op care only | $16.98 | $23.44 | $29.51 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $85.11 Median $117.49 Typical High $147.91 | Professional | 52 · Reduced service | $85.11 | $117.49 | $147.91 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $46.77 Typical High $58.88 | Professional | 53 · Discontinued | $33.88 | $46.77 | $58.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $173.78 Typical High $218.78 | Professional | 54 · Surgery only | $128.82 | $173.78 | $218.78 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $34.67 Typical High $43.65 | Professional | 55 · Aftercare only | $25.70 | $34.67 | $43.65 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $23.44 Typical High $29.51 | Professional | 56 · Pre-op care only | $16.98 | $23.44 | $29.51 |
Where Pennsylvania sits
The same service costs 3.7 times more in Alaska than in Maryland. 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· 41st of 51
$275
AK $813MD $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.