How much rates vary
Facilitymedian $457 · 10th to 90th $234 to $3,467Professionalmedian $245 · 10th to 90th $170 to $427
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 $234.42 Median $1,288.25 Typical High $6,165.95 | Facility | None | $234.42 | $1,288.25 | $6,165.95 |
Aetna Setting Professional Modifier None Typical Low $181.97 Median $269.15 Typical High $323.59 | Professional | None | $181.97 | $269.15 | $323.59 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $165.96 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $125.89 | $165.96 | $218.78 |
Ambetter Setting Professional Modifier None Typical Low $275.42 Median $323.59 Typical High $537.03 | Professional | None | $275.42 | $323.59 | $537.03 |
AmeriHealth Setting Facility Modifier None Typical Low $10,232.93 Median $10,232.93 Typical High $10,232.93 | Facility | None | $10,232.93 | $10,232.93 | $10,232.93 |
AmeriHealth Setting Professional Modifier None Typical Low $204.17 Median $309.03 Typical High $338.84 | Professional | None | $204.17 | $309.03 | $338.84 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,511.89 Median $2,570.40 Typical High $56,234.13 | Facility | None | $2,511.89 | $2,570.40 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $426.58 Median $426.58 Typical High $501.19 | Professional | None | $426.58 | $426.58 | $501.19 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $223.87 Median $354.81 Typical High $407.38 | Professional | 78 · Unplanned return to OR | $223.87 | $354.81 | $407.38 |
Cigna Setting Facility Modifier None Typical Low $245.47 Median $371.54 Typical High $630.96 | Facility | None | $245.47 | $371.54 | $630.96 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $213.80 Typical High $398.11 | Professional | None | $158.49 | $213.80 | $398.11 |
Emblem Health Setting Professional Modifier None Typical Low $389.05 Median $537.03 Typical High $707.95 | Professional | None | $389.05 | $537.03 | $707.95 |
Geisinger Setting Facility Modifier None Typical Low $229.09 Median $288.40 Typical High $512.86 | Facility | None | $229.09 | $288.40 | $512.86 |
Geisinger Setting Professional Modifier None Typical Low $158.49 Median $309.03 Typical High $512.86 | Professional | None | $158.49 | $309.03 | $512.86 |
Highmark BCBS Setting Facility Modifier None Typical Low $346.74 Median $1,202.26 Typical High $4,073.80 | Facility | None | $346.74 | $1,202.26 | $4,073.80 |
Highmark BCBS Setting Professional Modifier None Typical Low $213.80 Median $331.13 Typical High $478.63 | Professional | None | $213.80 | $331.13 | $478.63 |
Independence Blue Cross Setting Facility Modifier None Typical Low $707.95 Median $891.25 Typical High $10,232.93 | Facility | None | $707.95 | $891.25 | $10,232.93 |
Independence Blue Cross Setting Professional Modifier None Typical Low $204.17 Median $309.03 Typical High $338.84 | Professional | None | $204.17 | $309.03 | $338.84 |
Martin's Point Setting Facility Modifier None Typical Low $281.84 Median $1,513.56 Typical High $5,888.44 | Facility | None | $281.84 | $1,513.56 | $5,888.44 |
Martin's Point Setting Professional Modifier None Typical Low $181.97 Median $269.15 Typical High $309.03 | Professional | None | $181.97 | $269.15 | $309.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $169.82 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $125.89 | $169.82 | $218.78 |
Oscar Health Setting Facility Modifier None Typical Low $288.40 Median $1,023.29 Typical High $1,023.29 | Facility | None | $288.40 | $1,023.29 | $1,023.29 |
Oscar Health Setting Professional Modifier None Typical Low $177.83 Median $190.55 Typical High $501.19 | Professional | None | $177.83 | $190.55 | $501.19 |
UPMC Health Plan Setting Facility Modifier None Typical Low $165.96 Median $1,096.48 Typical High $2,511.89 | Facility | None | $165.96 | $1,096.48 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $165.96 Median $218.78 Typical High $275.42 | Professional | None | $165.96 | $218.78 | $275.42 |
United Setting Facility Modifier None Typical Low $199.53 Median $436.52 Typical High $2,290.87 | Facility | None | $199.53 | $436.52 | $2,290.87 |
United Setting Professional Modifier None Typical Low $165.96 Median $239.88 Typical High $363.08 | Professional | None | $165.96 | $239.88 | $363.08 |
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 $91.20 Median $117.49 Typical High $154.88 | Professional | 52 · Reduced service | $91.20 | $117.49 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $36.31 Median $46.77 Typical High $61.66 | Professional | 53 · Discontinued | $36.31 | $46.77 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $177.83 Typical High $234.42 | Professional | 54 · Surgery only | $134.90 | $177.83 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $35.48 Typical High $46.77 | Professional | 55 · Aftercare only | $26.92 | $35.48 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $23.44 Typical High $30.90 | Professional | 56 · Pre-op care only | $18.20 | $23.44 | $30.90 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $91.20 Median $123.03 Typical High $154.88 | Professional | 52 · Reduced service | $91.20 | $123.03 | $154.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $36.31 Median $48.98 Typical High $61.66 | Professional | 53 · Discontinued | $36.31 | $48.98 | $61.66 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $181.97 Typical High $234.42 | Professional | 54 · Surgery only | $134.90 | $181.97 | $234.42 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $26.92 Median $36.31 Typical High $46.77 | Professional | 55 · Aftercare only | $26.92 | $36.31 | $46.77 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $24.55 Typical High $30.90 | Professional | 56 · Pre-op care only | $18.20 | $24.55 | $30.90 |
Where Pennsylvania sits
The same service costs 3.8 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· 38th of 51
$251
AK $776KY $204
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.