How much rates vary
Facilitymedian $170 · 10th to 90th $78 to $3,020Professionalmedian $145 · 10th to 90th $93 to $214
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 $151.36 Median $2,344.23 Typical High $8,317.64 | Facility | None | $151.36 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $89.13 Median $144.54 Typical High $190.55 | Professional | None | $89.13 | $144.54 | $190.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $87.10 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $63.10 | $87.10 | $107.15 |
Ambetter Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | None | $204.17 | $204.17 | $204.17 |
AmeriHealth Setting Professional Modifier None Typical Low $154.88 Median $154.88 Typical High $162.18 | Professional | None | $154.88 | $154.88 | $162.18 |
Capital Blue Cross Setting Facility Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $8,709.64 | Facility | None | $1,202.26 | $1,412.54 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | None | $223.87 | $223.87 | $223.87 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $131.83 Median $134.90 Typical High $309.03 | Professional | 78 · Unplanned return to OR | $131.83 | $134.90 | $309.03 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $120.23 Typical High $218.78 | Facility | None | $50.12 | $120.23 | $218.78 |
Cigna Setting Professional Modifier None Typical Low $95.50 Median $138.04 Typical High $213.80 | Professional | None | $95.50 | $138.04 | $213.80 |
Emblem Health Setting Professional Modifier None Typical Low $275.42 Median $275.42 Typical High $275.42 | Professional | None | $275.42 | $275.42 | $275.42 |
Geisinger Setting Facility Modifier None Typical Low $104.71 Median $128.82 Typical High $229.09 | Facility | None | $104.71 | $128.82 | $229.09 |
Geisinger Setting Professional Modifier None Typical Low $123.03 Median $186.21 Typical High $269.15 | Professional | None | $123.03 | $186.21 | $269.15 |
Highmark BCBS Setting Facility Modifier None Typical Low $524.81 Median $912.01 Typical High $1,148.15 | Facility | None | $524.81 | $912.01 | $1,148.15 |
Highmark BCBS Setting Professional Modifier None Typical Low $131.83 Median $154.88 Typical High $199.53 | Professional | None | $131.83 | $154.88 | $199.53 |
Independence Blue Cross Setting Professional Modifier None Typical Low $154.88 Median $154.88 Typical High $162.18 | Professional | None | $154.88 | $154.88 | $162.18 |
Martin's Point Setting Facility Modifier None Typical Low $426.58 Median $2,137.96 Typical High $7,244.36 | Facility | None | $426.58 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $89.13 Median $144.54 Typical High $186.21 | Professional | None | $89.13 | $144.54 | $186.21 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $87.10 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $63.10 | $87.10 | $107.15 |
Oscar Health Setting Professional Modifier None Typical Low $144.54 Median $144.54 Typical High $316.23 | Professional | None | $144.54 | $144.54 | $316.23 |
UPMC Health Plan Setting Facility Modifier None Typical Low $93.33 Median $199.53 Typical High $457.09 | Facility | None | $93.33 | $199.53 | $457.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $93.33 Median $134.90 Typical High $162.18 | Professional | None | $93.33 | $134.90 | $162.18 |
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 $95.50 Median $144.54 Typical High $234.42 | Professional | None | $95.50 | $144.54 | $234.42 |
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 $44.67 Median $63.10 Typical High $75.86 | Professional | 52 · Reduced service | $44.67 | $63.10 | $75.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.78 Median $25.12 Typical High $30.20 | Professional | 53 · Discontinued | $17.78 | $25.12 | $30.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $93.33 Typical High $114.82 | Professional | 54 · Surgery only | $67.61 | $93.33 | $114.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $19.05 Typical High $22.91 | Professional | 55 · Aftercare only | $13.49 | $19.05 | $22.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $12.59 Typical High $15.14 | Professional | 56 · Pre-op care only | $8.91 | $12.59 | $15.14 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $44.67 Median $63.10 Typical High $75.86 | Professional | 52 · Reduced service | $44.67 | $63.10 | $75.86 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $17.78 Median $25.12 Typical High $30.20 | Professional | 53 · Discontinued | $17.78 | $25.12 | $30.20 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $93.33 Typical High $114.82 | Professional | 54 · Surgery only | $67.61 | $93.33 | $114.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $19.05 Typical High $22.91 | Professional | 55 · Aftercare only | $13.49 | $19.05 | $22.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.91 Median $12.59 Typical High $15.14 | Professional | 56 · Pre-op care only | $8.91 | $12.59 | $15.14 |
Where Pennsylvania sits
The same service costs 3.5 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· 41st of 51
$145
AK $427KY $123
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.