How much rates vary
Facilitymedian $3,090 · 10th to 90th $955 to $7,943Professionalmedian $1,047 · 10th to 90th $933 to $1,479
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 $1,023.29 Median $5,370.32 Typical High $8,709.64 | Facility | None | $1,023.29 | $5,370.32 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $1,000.00 Median $1,096.48 Typical High $1,148.15 | Professional | None | $1,000.00 | $1,096.48 | $1,148.15 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $758.58 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $691.83 | $758.58 | $794.33 |
Ambetter Setting Professional Modifier None Typical Low $1,122.02 Median $1,122.02 Typical High $1,122.02 | Professional | None | $1,122.02 | $1,122.02 | $1,122.02 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $56,234.13 | Facility | None | $3,981.07 | $7,413.10 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,548.82 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,548.82 | $1,548.82 | $1,548.82 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $831.76 Median $1,380.38 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $831.76 | $1,380.38 | $1,737.80 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $2,818.38 Typical High $4,897.79 | Facility | None | $707.95 | $2,818.38 | $4,897.79 |
Cigna Setting Professional Modifier None Typical Low $977.24 Median $1,000.00 Typical High $1,949.84 | Professional | None | $977.24 | $1,000.00 | $1,949.84 |
Emblem Health Setting Professional Modifier None Typical Low $1,174.90 Median $1,584.89 Typical High $2,137.96 | Professional | None | $1,174.90 | $1,584.89 | $2,137.96 |
Geisinger Setting Facility Modifier None Typical Low $2,951.21 Median $3,630.78 Typical High $6,456.54 | Facility | None | $2,951.21 | $3,630.78 | $6,456.54 |
Geisinger Setting Professional Modifier None Typical Low $912.01 Median $1,071.52 Typical High $1,862.09 | Professional | None | $912.01 | $1,071.52 | $1,862.09 |
Highmark BCBS Setting Facility Modifier None Typical Low $5,888.44 Median $14,125.38 Typical High $20,892.96 | Facility | None | $5,888.44 | $14,125.38 | $20,892.96 |
Martin's Point Setting Facility Modifier None Typical Low $1,047.13 Median $4,897.79 Typical High $8,709.64 | Facility | None | $1,047.13 | $4,897.79 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,000.00 Median $1,096.48 Typical High $1,148.15 | Professional | None | $1,000.00 | $1,096.48 | $1,148.15 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $758.58 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $691.83 | $758.58 | $794.33 |
Oscar Health Setting Professional Modifier None Typical Low $831.76 Median $891.25 Typical High $2,089.30 | Professional | None | $831.76 | $891.25 | $2,089.30 |
UPMC Health Plan Setting Facility Modifier None Typical Low $954.99 Median $2,570.40 Typical High $5,011.87 | Facility | None | $954.99 | $2,570.40 | $5,011.87 |
UPMC Health Plan Setting Professional Modifier None Typical Low $954.99 Median $1,023.29 Typical High $1,023.29 | Professional | None | $954.99 | $1,023.29 | $1,023.29 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,398.83 Typical High $6,918.31 | Facility | None | $1,380.38 | $2,398.83 | $6,918.31 |
United Setting Professional Modifier None Typical Low $891.25 Median $1,047.13 Typical High $1,698.24 | Professional | None | $891.25 | $1,047.13 | $1,698.24 |
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 $489.78 Median $549.54 Typical High $575.44 | Professional | 52 · Reduced service | $489.78 | $549.54 | $575.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $218.78 Typical High $229.09 | Professional | 53 · Discontinued | $199.53 | $218.78 | $229.09 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $812.83 Typical High $851.14 | Professional | 54 · Surgery only | $741.31 | $812.83 | $851.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $165.96 Typical High $169.82 | Professional | 55 · Aftercare only | $147.91 | $165.96 | $169.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $109.65 Typical High $114.82 | Professional | 56 · Pre-op care only | $100.00 | $109.65 | $114.82 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $489.78 Median $549.54 Typical High $575.44 | Professional | 52 · Reduced service | $489.78 | $549.54 | $575.44 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $218.78 Typical High $229.09 | Professional | 53 · Discontinued | $199.53 | $218.78 | $229.09 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $812.83 Typical High $851.14 | Professional | 54 · Surgery only | $741.31 | $812.83 | $851.14 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $165.96 Typical High $169.82 | Professional | 55 · Aftercare only | $147.91 | $165.96 | $169.82 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $109.65 Typical High $114.82 | Professional | 56 · Pre-op care only | $100.00 | $109.65 | $114.82 |
Where Pennsylvania sits
The same service costs 3.7 times more in Alaska than in West Virginia. 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
AK $10,315WV $2,808
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.