How much rates vary
Facilitymedian $525 · 10th to 90th $60 to $8,710Professionalmedian $62 · 10th to 90th $47 to $107
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 $57.54 Median $1,819.70 Typical High $7,943.28 | Facility | None | $57.54 | $1,819.70 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $46.77 Median $57.54 Typical High $93.33 | Professional | None | $46.77 | $57.54 | $93.33 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $33.11 Median $40.74 Typical High $43.65 | Professional | 78 · Unplanned return to OR | $33.11 | $40.74 | $43.65 |
Ambetter Setting Professional Modifier None Typical Low $54.95 Median $57.54 Typical High $93.33 | Professional | None | $54.95 | $57.54 | $93.33 |
AmeriHealth Setting Facility Modifier None Typical Low $4,466.84 Median $10,471.29 Typical High $15,848.93 | Facility | None | $4,466.84 | $10,471.29 | $15,848.93 |
AmeriHealth Setting Professional Modifier None Typical Low $24.55 Median $52.48 Typical High $61.66 | Professional | None | $24.55 | $52.48 | $61.66 |
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 $70.79 Median $72.44 Typical High $154.88 | Professional | None | $70.79 | $72.44 | $154.88 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $56.23 Median $58.88 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $56.23 | $58.88 | $125.89 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $309.03 | Facility | None | $50.12 | $66.07 | $309.03 |
Cigna Setting Professional Modifier None Typical Low $46.77 Median $63.10 Typical High $107.15 | Professional | None | $46.77 | $63.10 | $107.15 |
Emblem Health Setting Professional Modifier None Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | None | $112.20 | $112.20 | $112.20 |
Geisinger Setting Professional Modifier None Typical Low $56.23 Median $85.11 Typical High $114.82 | Professional | None | $56.23 | $85.11 | $114.82 |
Highmark BCBS Setting Facility Modifier None Typical Low $275.42 Median $676.08 Typical High $933.25 | Facility | None | $275.42 | $676.08 | $933.25 |
Highmark BCBS Setting Professional Modifier None Typical Low $58.88 Median $72.44 Typical High $93.33 | Professional | None | $58.88 | $72.44 | $93.33 |
Independence Blue Cross Setting Facility Modifier None Typical Low $2,238.72 Median $7,943.28 Typical High $15,848.93 | Facility | None | $2,238.72 | $7,943.28 | $15,848.93 |
Independence Blue Cross Setting Professional Modifier None Typical Low $24.55 Median $52.48 Typical High $61.66 | Professional | None | $24.55 | $52.48 | $61.66 |
Martin's Point Setting Facility Modifier None Typical Low $60.26 Median $1,737.80 Typical High $6,606.93 | Facility | None | $60.26 | $1,737.80 | $6,606.93 |
Martin's Point Setting Professional Modifier None Typical Low $46.77 Median $57.54 Typical High $95.50 | Professional | None | $46.77 | $57.54 | $95.50 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $33.11 Median $40.74 Typical High $43.65 | Professional | 78 · Unplanned return to OR | $33.11 | $40.74 | $43.65 |
Oscar Health Setting Professional Modifier None Typical Low $69.18 Median $69.18 Typical High $154.88 | Professional | None | $69.18 | $69.18 | $154.88 |
UPMC Health Plan Setting Facility Modifier None Typical Low $53.70 Median $194.98 Typical High $436.52 | Facility | None | $53.70 | $194.98 | $436.52 |
UPMC Health Plan Setting Professional Modifier None Typical Low $52.48 Median $63.10 Typical High $77.62 | Professional | None | $52.48 | $63.10 | $77.62 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,230.27 | Facility | None | $77.62 | $158.49 | $1,230.27 |
United Setting Professional Modifier None Typical Low $47.86 Median $60.26 Typical High $107.15 | Professional | None | $47.86 | $60.26 | $107.15 |
12 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 $23.44 Median $28.84 Typical High $30.90 | Professional | 52 · Reduced service | $23.44 | $28.84 | $30.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $11.48 Typical High $12.30 | Professional | 53 · Discontinued | $9.33 | $11.48 | $12.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $43.65 Typical High $46.77 | Professional | 54 · Surgery only | $35.48 | $43.65 | $46.77 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $8.71 Typical High $9.33 | Professional | 55 · Aftercare only | $7.08 | $8.71 | $9.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $5.75 Typical High $6.17 | Professional | 56 · Pre-op care only | $4.68 | $5.75 | $6.17 |
Highmark BCBS Setting Professional Modifier 59 · Distinct service Typical Low $58.88 Median $64.57 Typical High $74.13 | Professional | 59 · Distinct service | $58.88 | $64.57 | $74.13 |
Highmark BCBS Setting Professional Modifier XS · Separate structure Typical Low $54.95 Median $70.79 Typical High $93.33 | Professional | XS · Separate structure | $54.95 | $70.79 | $93.33 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $23.44 Median $28.84 Typical High $30.90 | Professional | 52 · Reduced service | $23.44 | $28.84 | $30.90 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $11.48 Typical High $12.30 | Professional | 53 · Discontinued | $9.33 | $11.48 | $12.30 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $43.65 Typical High $46.77 | Professional | 54 · Surgery only | $35.48 | $43.65 | $46.77 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $8.71 Typical High $9.33 | Professional | 55 · Aftercare only | $7.08 | $8.71 | $9.33 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $5.75 Typical High $6.17 | Professional | 56 · Pre-op care only | $4.68 | $5.75 | $6.17 |
Where Pennsylvania sits
The same service costs 4.2 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· 45th of 51
$61.66
AK $224KY $53.70
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.