How much rates vary
Facilitymedian $513 · 10th to 90th $115 to $3,890Professionalmedian $138 · 10th to 90th $102 to $182
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 $158.49 Median $1,995.26 Typical High $7,943.28 | Facility | None | $158.49 | $1,995.26 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $100.00 Median $138.04 Typical High $158.49 | Professional | None | $100.00 | $138.04 | $158.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $70.79 Median $95.50 Typical High $109.65 | Professional | 78 · Unplanned return to OR | $70.79 | $95.50 | $109.65 |
Ambetter Setting Professional Modifier None Typical Low $144.54 Median $144.54 Typical High $147.91 | Professional | None | $144.54 | $144.54 | $147.91 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,630.27 Median $3,019.95 Typical High $56,234.13 | Facility | None | $2,630.27 | $3,019.95 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | None | $141.25 | $141.25 | $141.25 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $186.21 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $114.82 | $186.21 | $234.42 |
Cigna Setting Facility Modifier None Typical Low $107.15 Median $275.42 Typical High $549.54 | Facility | None | $107.15 | $275.42 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $102.33 Median $134.90 Typical High $218.78 | Professional | None | $102.33 | $134.90 | $218.78 |
Emblem Health Setting Professional Modifier None Typical Low $177.83 Median $245.47 Typical High $323.59 | Professional | None | $177.83 | $245.47 | $323.59 |
Geisinger Setting Facility Modifier None Typical Low $97.72 Median $120.23 Typical High $213.80 | Facility | None | $97.72 | $120.23 | $213.80 |
Geisinger Setting Professional Modifier None Typical Low $109.65 Median $151.36 Typical High $263.03 | Professional | None | $109.65 | $151.36 | $263.03 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,819.70 Median $3,388.44 Typical High $7,244.36 | Facility | None | $1,819.70 | $3,388.44 | $7,244.36 |
Martin's Point Setting Facility Modifier None Typical Low $158.49 Median $1,995.26 Typical High $6,606.93 | Facility | None | $158.49 | $1,995.26 | $6,606.93 |
Martin's Point Setting Professional Modifier None Typical Low $100.00 Median $138.04 Typical High $158.49 | Professional | None | $100.00 | $138.04 | $158.49 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $70.79 Median $95.50 Typical High $109.65 | Professional | 78 · Unplanned return to OR | $70.79 | $95.50 | $109.65 |
Oscar Health Setting Professional Modifier None Typical Low $151.36 Median $162.18 Typical High $295.12 | Professional | None | $151.36 | $162.18 | $295.12 |
UPMC Health Plan Setting Facility Modifier None Typical Low $107.15 Median $223.87 Typical High $457.09 | Facility | None | $107.15 | $223.87 | $457.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $107.15 Median $138.04 Typical High $141.25 | Professional | None | $107.15 | $138.04 | $141.25 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,467.37 | Facility | None | $416.87 | $724.44 | $3,467.37 |
United Setting Professional Modifier None Typical Low $93.33 Median $131.83 Typical High $199.53 | Professional | None | $93.33 | $131.83 | $199.53 |
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 $50.12 Median $67.61 Typical High $79.43 | Professional | 52 · Reduced service | $50.12 | $67.61 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $26.92 Typical High $31.62 | Professional | 53 · Discontinued | $20.42 | $26.92 | $31.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $102.33 Typical High $117.49 | Professional | 54 · Surgery only | $75.86 | $102.33 | $117.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $20.42 Typical High $23.44 | Professional | 55 · Aftercare only | $15.14 | $20.42 | $23.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $13.49 Typical High $15.85 | Professional | 56 · Pre-op care only | $10.00 | $13.49 | $15.85 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $50.12 Median $67.61 Typical High $79.43 | Professional | 52 · Reduced service | $50.12 | $67.61 | $79.43 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $26.92 Typical High $31.62 | Professional | 53 · Discontinued | $20.42 | $26.92 | $31.62 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $102.33 Typical High $117.49 | Professional | 54 · Surgery only | $75.86 | $102.33 | $117.49 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $20.42 Typical High $23.44 | Professional | 55 · Aftercare only | $15.14 | $20.42 | $23.44 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $13.49 Typical High $15.85 | Professional | 56 · Pre-op care only | $10.00 | $13.49 | $15.85 |
Where Pennsylvania sits
The same service costs 4.0 times more in Alaska than in New Jersey. 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· 39th of 51
$138
AK $437NJ $110
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.