How much rates vary
Facilitymedian $263 · 10th to 90th $78 to $3,467Professionalmedian $191 · 10th to 90th $115 to $295
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 $134.90 Median $302.00 Typical High $8,317.64 | Facility | None | $134.90 | $302.00 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $199.53 Typical High $263.03 | Professional | None | $120.23 | $199.53 | $263.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $83.18 Median $120.23 Typical High $162.18 | Professional | 78 · Unplanned return to OR | $83.18 | $120.23 | $162.18 |
Ambetter Setting Professional Modifier None Typical Low $181.97 Median $181.97 Typical High $181.97 | Professional | None | $181.97 | $181.97 | $181.97 |
AmeriHealth Setting Facility Modifier None Typical Low $707.95 Median $1,698.24 Typical High $2,691.53 | Facility | None | $707.95 | $1,698.24 | $2,691.53 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $5,011.87 Typical High $56,234.13 | Facility | None | $3,981.07 | $5,011.87 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $194.98 Median $194.98 Typical High $56,234.13 | Professional | None | $194.98 | $194.98 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $158.49 Median $234.42 Typical High $295.12 | Professional | 78 · Unplanned return to OR | $158.49 | $234.42 | $295.12 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $120.23 | Facility | None | $50.12 | $66.07 | $120.23 |
Cigna Setting Professional Modifier None Typical Low $112.20 Median $199.53 Typical High $331.13 | Professional | None | $112.20 | $199.53 | $331.13 |
Emblem Health Setting Professional Modifier None Typical Low $354.81 Median $354.81 Typical High $363.08 | Professional | None | $354.81 | $354.81 | $363.08 |
Geisinger Setting Professional Modifier None Typical Low $120.23 Median $229.09 Typical High $363.08 | Professional | None | $120.23 | $229.09 | $363.08 |
Highmark BCBS Setting Facility Modifier None Typical Low $213.80 Median $316.23 Typical High $436.52 | Facility | None | $213.80 | $316.23 | $436.52 |
Independence Blue Cross Setting Facility Modifier None Typical Low $181.97 Median $1,698.24 Typical High $2,691.53 | Facility | None | $181.97 | $1,698.24 | $2,691.53 |
Martin's Point Setting Facility Modifier None Typical Low $134.90 Median $316.23 Typical High $8,317.64 | Facility | None | $134.90 | $316.23 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $120.23 Median $199.53 Typical High $269.15 | Professional | None | $120.23 | $199.53 | $269.15 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $83.18 Median $120.23 Typical High $162.18 | Professional | 78 · Unplanned return to OR | $83.18 | $120.23 | $162.18 |
Oscar Health Setting Professional Modifier None Typical Low $141.25 Median $147.91 Typical High $446.68 | Professional | None | $141.25 | $147.91 | $446.68 |
UPMC Health Plan Setting Facility Modifier None Typical Low $120.23 Median $194.98 Typical High $295.12 | Facility | None | $120.23 | $194.98 | $295.12 |
UPMC Health Plan Setting Professional Modifier None Typical Low $120.23 Median $194.98 Typical High $204.17 | Professional | None | $120.23 | $194.98 | $204.17 |
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 $100.00 Median $173.78 Typical High $309.03 | Professional | None | $100.00 | $173.78 | $309.03 |
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 $58.88 Median $87.10 Typical High $114.82 | Professional | 52 · Reduced service | $58.88 | $87.10 | $114.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $37.15 Typical High $45.71 | Professional | 53 · Discontinued | $23.99 | $37.15 | $45.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $128.82 Typical High $173.78 | Professional | 54 · Surgery only | $89.13 | $128.82 | $173.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.78 Median $28.18 Typical High $34.67 | Professional | 55 · Aftercare only | $17.78 | $28.18 | $34.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.75 Median $18.62 Typical High $22.91 | Professional | 56 · Pre-op care only | $11.75 | $18.62 | $22.91 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $58.88 Median $87.10 Typical High $114.82 | Professional | 52 · Reduced service | $58.88 | $87.10 | $114.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $37.15 Typical High $45.71 | Professional | 53 · Discontinued | $23.99 | $37.15 | $45.71 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $128.82 Typical High $173.78 | Professional | 54 · Surgery only | $89.13 | $128.82 | $173.78 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $17.78 Median $28.18 Typical High $34.67 | Professional | 55 · Aftercare only | $17.78 | $28.18 | $34.67 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $11.75 Median $18.62 Typical High $22.91 | Professional | 56 · Pre-op care only | $11.75 | $18.62 | $22.91 |
Where Pennsylvania sits
The same service costs 4.5 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· 37th of 51
$195
AK $501KY $112
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.