How much rates vary
Facilitymedian $5,248 · 10th to 90th $1,445 to $13,183Professionalmedian $1,148 · 10th to 90th $1,000 to $2,138
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 $1,000.00 Median $5,495.41 Typical High $10,964.78 | Facility | None | $1,000.00 | $5,495.41 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $891.25 Median $1,000.00 Typical High $1,348.96 | Professional | None | $891.25 | $1,000.00 | $1,348.96 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $691.83 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $630.96 | $691.83 | $741.31 |
Ambetter Setting Professional Modifier None Typical Low $1,698.24 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,698.24 | $1,698.24 | $1,698.24 |
AmeriHealth Setting Facility Modifier None Typical Low $4,265.80 Median $5,495.41 Typical High $38,018.94 | Facility | None | $4,265.80 | $5,495.41 | $38,018.94 |
AmeriHealth Setting Professional Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,380.38 | Professional | None | $1,174.90 | $1,174.90 | $1,380.38 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $12,022.64 Typical High $56,234.13 | Facility | None | $3,981.07 | $12,022.64 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,122.02 Median $1,778.28 Typical High $2,187.76 | Professional | None | $1,122.02 | $1,778.28 | $2,187.76 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $831.76 Median $1,318.26 Typical High $1,621.81 | Professional | 78 · Unplanned return to OR | $831.76 | $1,318.26 | $1,621.81 |
Cigna Setting Facility Modifier None Typical Low $1,318.26 Median $4,786.30 Typical High $8,128.31 | Facility | None | $1,318.26 | $4,786.30 | $8,128.31 |
Cigna Setting Professional Modifier None Typical Low $1,047.13 Median $1,202.26 Typical High $2,137.96 | Professional | None | $1,047.13 | $1,202.26 | $2,137.96 |
Emblem Health Setting Professional Modifier None Typical Low $1,548.82 Median $1,548.82 Typical High $1,698.24 | Professional | None | $1,548.82 | $1,548.82 | $1,698.24 |
Geisinger Setting Facility Modifier None Typical Low $5,011.87 Median $6,165.95 Typical High $10,964.78 | Facility | None | $5,011.87 | $6,165.95 | $10,964.78 |
Geisinger Setting Professional Modifier None Typical Low $1,000.00 Median $1,348.96 Typical High $2,290.87 | Professional | None | $1,000.00 | $1,348.96 | $2,290.87 |
Highmark BCBS Setting Facility Modifier None Typical Low $10,964.78 Median $29,512.09 Typical High $51,286.14 | Facility | None | $10,964.78 | $29,512.09 | $51,286.14 |
Independence Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $5,495.41 Typical High $26,915.35 | Facility | None | $3,981.07 | $5,495.41 | $26,915.35 |
Independence Blue Cross Setting Professional Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,380.38 | Professional | None | $1,174.90 | $1,174.90 | $1,380.38 |
Martin's Point Setting Facility Modifier None Typical Low $1,000.00 Median $5,248.07 Typical High $11,748.98 | Facility | None | $1,000.00 | $5,248.07 | $11,748.98 |
Martin's Point Setting Professional Modifier None Typical Low $891.25 Median $1,000.00 Typical High $1,380.38 | Professional | None | $891.25 | $1,000.00 | $1,380.38 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $691.83 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $630.96 | $691.83 | $741.31 |
Oscar Health Setting Professional Modifier None Typical Low $1,258.93 Median $1,318.26 Typical High $2,290.87 | Professional | None | $1,258.93 | $1,318.26 | $2,290.87 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,096.48 Median $8,511.38 Typical High $14,791.08 | Facility | None | $1,096.48 | $8,511.38 | $14,791.08 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,096.48 Median $1,174.90 Typical High $1,174.90 | Professional | None | $1,096.48 | $1,174.90 | $1,174.90 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,235.94 Typical High $10,715.19 | Facility | None | $1,698.24 | $3,235.94 | $10,715.19 |
United Setting Professional Modifier None Typical Low $1,023.29 Median $1,318.26 Typical High $2,290.87 | Professional | None | $1,023.29 | $1,318.26 | $2,290.87 |
11 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 $446.68 Median $501.19 Typical High $524.81 | Professional | 52 · Reduced service | $446.68 | $501.19 | $524.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $181.97 Median $199.53 Typical High $213.80 | Professional | 53 · Discontinued | $181.97 | $199.53 | $213.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $676.08 Median $741.31 Typical High $794.33 | Professional | 54 · Surgery only | $676.08 | $741.31 | $794.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $134.90 Median $147.91 Typical High $158.49 | Professional | 55 · Aftercare only | $134.90 | $147.91 | $158.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $89.13 Median $100.00 Typical High $104.71 | Professional | 56 · Pre-op care only | $89.13 | $100.00 | $104.71 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $446.68 Median $501.19 Typical High $524.81 | Professional | 52 · Reduced service | $446.68 | $501.19 | $524.81 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $181.97 Median $199.53 Typical High $213.80 | Professional | 53 · Discontinued | $181.97 | $199.53 | $213.80 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $676.08 Median $741.31 Typical High $794.33 | Professional | 54 · Surgery only | $676.08 | $741.31 | $794.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $134.90 Median $147.91 Typical High $158.49 | Professional | 55 · Aftercare only | $134.90 | $147.91 | $158.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $89.13 Median $100.00 Typical High $104.71 | Professional | 56 · Pre-op care only | $89.13 | $100.00 | $104.71 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $954.99 Median $1,023.29 Typical High $1,023.29 | Professional | 62 · Two surgeons | $954.99 | $1,023.29 | $1,023.29 |
Where Pennsylvania sits
The same service costs 4.8 times more in Colorado 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
CO $16,076MT $3,358
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.