How much rates vary
Facilitymedian $1,905 · 10th to 90th $603 to $7,943Professionalmedian $214 · 10th to 90th $191 to $316
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 $223.87 Median $3,981.07 Typical High $8,709.64 | Facility | None | $223.87 | $3,981.07 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $223.87 Typical High $251.19 | Professional | None | $194.98 | $223.87 | $251.19 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $151.36 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $138.04 | $151.36 | $158.49 |
Ambetter Setting Professional Modifier None Typical Low $89.13 Median $141.25 Typical High $177.83 | Professional | None | $89.13 | $141.25 | $177.83 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $8,709.64 | Facility | None | $3,981.07 | $7,413.10 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $169.82 Median $190.55 Typical High $309.03 | Professional | None | $169.82 | $190.55 | $309.03 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $173.78 Median $275.42 Typical High $380.19 | Professional | 78 · Unplanned return to OR | $173.78 | $275.42 | $380.19 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,445.44 Typical High $2,818.38 | Facility | None | $616.60 | $1,445.44 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $190.55 Median $208.93 Typical High $398.11 | Professional | None | $190.55 | $208.93 | $398.11 |
Emblem Health Setting Professional Modifier None Typical Low $234.42 Median $316.23 Typical High $426.58 | Professional | None | $234.42 | $316.23 | $426.58 |
Geisinger Setting Facility Modifier None Typical Low $1,445.44 Median $1,778.28 Typical High $3,162.28 | Facility | None | $1,445.44 | $1,778.28 | $3,162.28 |
Geisinger Setting Professional Modifier None Typical Low $190.55 Median $213.80 Typical High $371.54 | Professional | None | $190.55 | $213.80 | $371.54 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,041.74 Median $5,248.07 Typical High $13,182.57 | Facility | None | $2,041.74 | $5,248.07 | $13,182.57 |
Highmark BCBS Setting Professional Modifier None Typical Low $213.80 Median $213.80 Typical High $295.12 | Professional | None | $213.80 | $213.80 | $295.12 |
Independence Blue Cross Setting Facility Modifier None Typical Low $4,570.88 Median $5,011.87 Typical High $7,762.47 | Facility | None | $4,570.88 | $5,011.87 | $7,762.47 |
Martin's Point Setting Facility Modifier None Typical Low $223.87 Median $3,981.07 Typical High $10,000.00 | Facility | None | $223.87 | $3,981.07 | $10,000.00 |
Martin's Point Setting Professional Modifier None Typical Low $194.98 Median $218.78 Typical High $239.88 | Professional | None | $194.98 | $218.78 | $239.88 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $151.36 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $138.04 | $151.36 | $158.49 |
Oscar Health Setting Professional Modifier None Typical Low $218.78 Median $229.09 Typical High $416.87 | Professional | None | $218.78 | $229.09 | $416.87 |
UPMC Health Plan Setting Facility Modifier None Typical Low $208.93 Median $2,570.40 Typical High $5,011.87 | Facility | None | $208.93 | $2,570.40 | $5,011.87 |
UPMC Health Plan Setting Professional Modifier None Typical Low $208.93 Median $213.80 Typical High $269.15 | Professional | None | $208.93 | $213.80 | $269.15 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,570.88 | Facility | None | $812.83 | $1,318.26 | $4,570.88 |
United Setting Professional Modifier None Typical Low $181.97 Median $208.93 Typical High $331.13 | Professional | None | $181.97 | $208.93 | $331.13 |
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 $97.72 Median $109.65 Typical High $112.20 | Professional | 52 · Reduced service | $97.72 | $109.65 | $112.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $43.65 Typical High $44.67 | Professional | 53 · Discontinued | $38.90 | $43.65 | $44.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $162.18 Typical High $169.82 | Professional | 54 · Surgery only | $147.91 | $162.18 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $32.36 Typical High $33.88 | Professional | 55 · Aftercare only | $29.51 | $32.36 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $21.88 Typical High $22.39 | Professional | 56 · Pre-op care only | $19.50 | $21.88 | $22.39 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $97.72 Median $109.65 Typical High $112.20 | Professional | 52 · Reduced service | $97.72 | $109.65 | $112.20 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $43.65 Typical High $44.67 | Professional | 53 · Discontinued | $38.90 | $43.65 | $44.67 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $162.18 Typical High $169.82 | Professional | 54 · Surgery only | $147.91 | $162.18 | $169.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $32.36 Typical High $33.88 | Professional | 55 · Aftercare only | $29.51 | $32.36 | $33.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $21.88 Typical High $22.39 | Professional | 56 · Pre-op care only | $19.50 | $21.88 | $22.39 |
Where Pennsylvania sits
The same service costs 5.6 times more in Alaska than in Utah. 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· 42nd of 51
$214
AK $871UT $155
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.