How much rates vary
Facilitymedian $2,188 · 10th to 90th $550 to $7,762Professionalmedian $479 · 10th to 90th $347 to $813
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 $446.68 Median $1,584.89 Typical High $8,511.38 | Facility | None | $446.68 | $1,584.89 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $346.74 Median $478.63 Typical High $588.84 | Professional | None | $346.74 | $478.63 | $588.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $239.88 Median $323.59 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $239.88 | $323.59 | $389.05 |
Ambetter Setting Professional Modifier None Typical Low $354.81 Median $354.81 Typical High $354.81 | Professional | None | $354.81 | $354.81 | $354.81 |
AmeriHealth Setting Facility Modifier None Typical Low $1,995.26 Median $3,715.35 Typical High $17,782.79 | Facility | None | $1,995.26 | $3,715.35 | $17,782.79 |
AmeriHealth Setting Professional Modifier None Typical Low $316.23 Median $398.11 Typical High $398.11 | Professional | None | $316.23 | $398.11 | $398.11 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $6,025.60 Typical High $8,709.64 | Facility | None | $3,981.07 | $6,025.60 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $524.81 Median $549.54 Typical High $1,047.13 | Professional | None | $524.81 | $549.54 | $1,047.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $363.08 Median $380.19 Typical High $724.44 | Professional | 78 · Unplanned return to OR | $363.08 | $380.19 | $724.44 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,584.89 Typical High $2,691.53 | Facility | None | $501.19 | $1,584.89 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $316.23 Median $407.38 Typical High $794.33 | Professional | None | $316.23 | $407.38 | $794.33 |
Emblem Health Setting Professional Modifier None Typical Low $707.95 Median $933.25 Typical High $933.25 | Professional | None | $707.95 | $933.25 | $933.25 |
Geisinger Setting Facility Modifier None Typical Low $1,584.89 Median $1,995.26 Typical High $3,467.37 | Facility | None | $1,584.89 | $1,995.26 | $3,467.37 |
Geisinger Setting Professional Modifier None Typical Low $323.59 Median $524.81 Typical High $912.01 | Professional | None | $323.59 | $524.81 | $912.01 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,318.26 Median $4,168.69 Typical High $10,964.78 | Facility | None | $1,318.26 | $4,168.69 | $10,964.78 |
Highmark BCBS Setting Professional Modifier None Typical Low $363.08 Median $416.87 Typical High $549.54 | Professional | None | $363.08 | $416.87 | $549.54 |
Independence Blue Cross Setting Facility Modifier None Typical Low $1,995.26 Median $3,715.35 Typical High $10,471.29 | Facility | None | $1,995.26 | $3,715.35 | $10,471.29 |
Independence Blue Cross Setting Professional Modifier None Typical Low $316.23 Median $338.84 Typical High $398.11 | Professional | None | $316.23 | $338.84 | $398.11 |
Martin's Point Setting Facility Modifier None Typical Low $478.63 Median $3,162.28 Typical High $8,511.38 | Facility | None | $478.63 | $3,162.28 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $346.74 Median $478.63 Typical High $562.34 | Professional | None | $346.74 | $478.63 | $562.34 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $239.88 Median $323.59 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $239.88 | $323.59 | $389.05 |
Oscar Health Setting Facility Modifier None Typical Low $1,949.84 Median $4,786.30 Typical High $6,606.93 | Facility | None | $1,949.84 | $4,786.30 | $6,606.93 |
Oscar Health Setting Professional Modifier None Typical Low $537.03 Median $537.03 Typical High $891.25 | Professional | None | $537.03 | $537.03 | $891.25 |
UPMC Health Plan Setting Facility Modifier None Typical Low $426.58 Median $1,230.27 Typical High $2,884.03 | Facility | None | $426.58 | $1,230.27 | $2,884.03 |
UPMC Health Plan Setting Professional Modifier None Typical Low $371.54 Median $489.78 Typical High $512.86 | Professional | None | $371.54 | $489.78 | $512.86 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,348.96 Typical High $4,466.84 | Facility | None | $812.83 | $1,348.96 | $4,466.84 |
United Setting Professional Modifier None Typical Low $338.84 Median $457.09 Typical High $741.31 | Professional | None | $338.84 | $457.09 | $741.31 |
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 $169.82 Median $229.09 Typical High $275.42 | Professional | 52 · Reduced service | $169.82 | $229.09 | $275.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $93.33 Typical High $112.20 | Professional | 53 · Discontinued | $69.18 | $93.33 | $112.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $257.04 Median $346.74 Typical High $416.87 | Professional | 54 · Surgery only | $257.04 | $346.74 | $416.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $51.29 Median $69.18 Typical High $83.18 | Professional | 55 · Aftercare only | $51.29 | $69.18 | $83.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $46.77 Typical High $54.95 | Professional | 56 · Pre-op care only | $34.67 | $46.77 | $54.95 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $794.33 Median $831.76 Typical High $1,548.82 | Professional | 50 · Both sides | $794.33 | $831.76 | $1,548.82 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $169.82 Median $229.09 Typical High $275.42 | Professional | 52 · Reduced service | $169.82 | $229.09 | $275.42 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $93.33 Typical High $112.20 | Professional | 53 · Discontinued | $69.18 | $93.33 | $112.20 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $257.04 Median $346.74 Typical High $416.87 | Professional | 54 · Surgery only | $257.04 | $346.74 | $416.87 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $51.29 Median $69.18 Typical High $83.18 | Professional | 55 · Aftercare only | $51.29 | $69.18 | $83.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $46.77 Typical High $54.95 | Professional | 56 · Pre-op care only | $34.67 | $46.77 | $54.95 |
Where Pennsylvania sits
The same service costs 4.5 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 $6,173MT $1,358
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.