How much rates vary
Facilitymedian $3,981 · 10th to 90th $813 to $13,183Professionalmedian $741 · 10th to 90th $646 to $1,259
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 $741.31 Median $3,715.35 Typical High $14,791.08 | Facility | None | $741.31 | $3,715.35 | $14,791.08 |
Aetna Setting Professional Modifier None Typical Low $645.65 Median $707.95 Typical High $851.14 | Professional | None | $645.65 | $707.95 | $851.14 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $446.68 Median $489.78 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $446.68 | $489.78 | $512.86 |
Ambetter Setting Professional Modifier None Typical Low $1,288.25 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,288.25 | $1,288.25 | $1,288.25 |
AmeriHealth Setting Facility Modifier None Typical Low $2,951.21 Median $5,011.87 Typical High $17,782.79 | Facility | None | $2,951.21 | $5,011.87 | $17,782.79 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $12,022.64 Typical High $56,234.13 | Facility | None | $3,981.07 | $12,022.64 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $724.44 Median $758.58 Typical High $1,348.96 | Professional | None | $724.44 | $758.58 | $1,348.96 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $501.19 Median $512.86 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $501.19 | $512.86 | $933.25 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $2,691.53 Typical High $7,585.78 | Facility | None | $501.19 | $2,691.53 | $7,585.78 |
Cigna Setting Professional Modifier None Typical Low $676.08 Median $724.44 Typical High $1,584.89 | Professional | None | $676.08 | $724.44 | $1,584.89 |
Emblem Health Setting Professional Modifier None Typical Low $870.96 Median $1,148.15 Typical High $1,148.15 | Professional | None | $870.96 | $1,148.15 | $1,148.15 |
Geisinger Setting Facility Modifier None Typical Low $4,570.88 Median $5,754.40 Typical High $10,000.00 | Facility | None | $4,570.88 | $5,754.40 | $10,000.00 |
Geisinger Setting Professional Modifier None Typical Low $562.34 Median $812.83 Typical High $1,445.44 | Professional | None | $562.34 | $812.83 | $1,445.44 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,951.21 Median $11,481.54 Typical High $29,512.09 | Facility | None | $2,951.21 | $11,481.54 | $29,512.09 |
Highmark BCBS Setting Professional Modifier None Typical Low $660.69 Median $794.33 Typical High $954.99 | Professional | None | $660.69 | $794.33 | $954.99 |
Independence Blue Cross Setting Facility Modifier None Typical Low $2,754.23 Median $4,073.80 Typical High $11,481.54 | Facility | None | $2,754.23 | $4,073.80 | $11,481.54 |
Martin's Point Setting Facility Modifier None Typical Low $741.31 Median $3,715.35 Typical High $14,791.08 | Facility | None | $741.31 | $3,715.35 | $14,791.08 |
Martin's Point Setting Professional Modifier None Typical Low $645.65 Median $691.83 Typical High $851.14 | Professional | None | $645.65 | $691.83 | $851.14 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $446.68 Median $489.78 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $446.68 | $489.78 | $512.86 |
Oscar Health Setting Professional Modifier None Typical Low $831.76 Median $954.99 Typical High $1,445.44 | Professional | None | $831.76 | $954.99 | $1,445.44 |
UPMC Health Plan Setting Facility Modifier None Typical Low $707.95 Median $1,737.80 Typical High $3,388.44 | Facility | None | $707.95 | $1,737.80 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $707.95 Median $870.96 Typical High $870.96 | Professional | None | $707.95 | $870.96 | $870.96 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,454.71 Typical High $6,918.31 | Facility | None | $1,380.38 | $2,454.71 | $6,918.31 |
United Setting Professional Modifier None Typical Low $676.08 Median $776.25 Typical High $1,174.90 | Professional | None | $676.08 | $776.25 | $1,174.90 |
11 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 $323.59 Median $346.74 Typical High $371.54 | Professional | 52 · Reduced service | $323.59 | $346.74 | $371.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $128.82 Median $141.25 Typical High $147.91 | Professional | 53 · Discontinued | $128.82 | $141.25 | $147.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $478.63 Median $524.81 Typical High $549.54 | Professional | 54 · Surgery only | $478.63 | $524.81 | $549.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $104.71 Typical High $109.65 | Professional | 55 · Aftercare only | $95.50 | $104.71 | $109.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $64.57 Median $69.18 Typical High $74.13 | Professional | 56 · Pre-op care only | $64.57 | $69.18 | $74.13 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,096.48 Median $1,122.02 Typical High $2,041.74 | Professional | 50 · Both sides | $1,096.48 | $1,122.02 | $2,041.74 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $323.59 Median $346.74 Typical High $371.54 | Professional | 52 · Reduced service | $323.59 | $346.74 | $371.54 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $128.82 Median $138.04 Typical High $147.91 | Professional | 53 · Discontinued | $128.82 | $138.04 | $147.91 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $478.63 Median $524.81 Typical High $549.54 | Professional | 54 · Surgery only | $478.63 | $524.81 | $549.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $104.71 Typical High $109.65 | Professional | 55 · Aftercare only | $95.50 | $104.71 | $109.65 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $64.57 Median $69.18 Typical High $74.13 | Professional | 56 · Pre-op care only | $64.57 | $69.18 | $74.13 |
Where Pennsylvania sits
The same service costs 6.0 times more in Colorado than in Montana. 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.
Physician feeFacility fee
CO $13,882MT $2,323
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.