How much rates vary
Facilitymedian $2,455 · 10th to 90th $776 to $8,318Professionalmedian $562 · 10th to 90th $468 to $1,000
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 $575.44 Median $4,073.80 Typical High $8,709.64 | Facility | None | $575.44 | $4,073.80 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $467.74 Median $524.81 Typical High $891.25 | Professional | None | $467.74 | $524.81 | $891.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $331.13 Median $371.54 Typical High $380.19 | Professional | 78 · Unplanned return to OR | $331.13 | $371.54 | $380.19 |
Ambetter Setting Professional Modifier None Typical Low $1,023.29 Median $1,023.29 Typical High $1,023.29 | Professional | None | $1,023.29 | $1,023.29 | $1,023.29 |
AmeriHealth Setting Facility Modifier None Typical Low $3,981.07 Median $5,495.41 Typical High $15,135.61 | Facility | None | $3,981.07 | $5,495.41 | $15,135.61 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $6,025.60 Typical High $56,234.13 | Facility | None | $3,981.07 | $6,025.60 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $933.25 Median $933.25 Typical High $56,234.13 | Professional | None | $933.25 | $933.25 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $426.58 Median $630.96 Typical High $776.25 | Professional | 78 · Unplanned return to OR | $426.58 | $630.96 | $776.25 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,737.80 Typical High $3,235.94 | Facility | None | $707.95 | $1,737.80 | $3,235.94 |
Cigna Setting Professional Modifier None Typical Low $501.19 Median $562.34 Typical High $1,071.52 | Professional | None | $501.19 | $562.34 | $1,071.52 |
Emblem Health Setting Professional Modifier None Typical Low $870.96 Median $870.96 Typical High $954.99 | Professional | None | $870.96 | $870.96 | $954.99 |
Geisinger Setting Facility Modifier None Typical Low $1,698.24 Median $2,089.30 Typical High $3,715.35 | Facility | None | $1,698.24 | $2,089.30 | $3,715.35 |
Geisinger Setting Professional Modifier None Typical Low $501.19 Median $691.83 Typical High $1,148.15 | Professional | None | $501.19 | $691.83 | $1,148.15 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,570.40 Median $6,918.31 Typical High $12,302.69 | Facility | None | $2,570.40 | $6,918.31 | $12,302.69 |
Independence Blue Cross Setting Facility Modifier None Typical Low $3,630.78 Median $5,495.41 Typical High $18,620.87 | Facility | None | $3,630.78 | $5,495.41 | $18,620.87 |
Martin's Point Setting Facility Modifier None Typical Low $537.03 Median $4,365.16 Typical High $8,709.64 | Facility | None | $537.03 | $4,365.16 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $467.74 Median $524.81 Typical High $891.25 | Professional | None | $467.74 | $524.81 | $891.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $331.13 Median $371.54 Typical High $380.19 | Professional | 78 · Unplanned return to OR | $331.13 | $371.54 | $380.19 |
Oscar Health Setting Professional Modifier None Typical Low $602.56 Median $660.69 Typical High $1,023.29 | Professional | None | $602.56 | $660.69 | $1,023.29 |
UPMC Health Plan Setting Facility Modifier None Typical Low $524.81 Median $2,570.40 Typical High $5,011.87 | Facility | None | $524.81 | $2,570.40 | $5,011.87 |
UPMC Health Plan Setting Professional Modifier None Typical Low $524.81 Median $524.81 Typical High $575.44 | Professional | None | $524.81 | $524.81 | $575.44 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,466.84 | Facility | None | $812.83 | $1,318.26 | $4,466.84 |
United Setting Professional Modifier None Typical Low $501.19 Median $645.65 Typical High $1,096.48 | Professional | None | $501.19 | $645.65 | $1,096.48 |
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 $234.42 Median $263.03 Typical High $269.15 | Professional | 52 · Reduced service | $234.42 | $263.03 | $269.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $104.71 Typical High $109.65 | Professional | 53 · Discontinued | $93.33 | $104.71 | $109.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $354.81 Median $398.11 Typical High $407.38 | Professional | 54 · Surgery only | $354.81 | $398.11 | $407.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $79.43 Typical High $81.28 | Professional | 55 · Aftercare only | $70.79 | $79.43 | $81.28 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $52.48 Typical High $53.70 | Professional | 56 · Pre-op care only | $46.77 | $52.48 | $53.70 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $234.42 Median $263.03 Typical High $269.15 | Professional | 52 · Reduced service | $234.42 | $263.03 | $269.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $104.71 Typical High $107.15 | Professional | 53 · Discontinued | $93.33 | $104.71 | $107.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $354.81 Median $398.11 Typical High $407.38 | Professional | 54 · Surgery only | $354.81 | $398.11 | $407.38 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $79.43 Typical High $81.28 | Professional | 55 · Aftercare only | $70.79 | $79.43 | $81.28 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $52.48 Typical High $53.70 | Professional | 56 · Pre-op care only | $46.77 | $52.48 | $53.70 |
Where Pennsylvania sits
The same service costs 3.6 times more in Oklahoma than in Montana. 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
OK $6,446MT $1,806
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.