How much rates vary
Facilitymedian $501 · 10th to 90th $200 to $2,754Professionalmedian $288 · 10th to 90th $224 to $417
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 $323.59 Median $2,344.23 Typical High $8,317.64 | Facility | None | $323.59 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $223.87 Median $288.40 Typical High $354.81 | Professional | None | $223.87 | $288.40 | $354.81 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $158.49 Median $199.53 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $158.49 | $199.53 | $229.09 |
Ambetter Setting Professional Modifier None Typical Low $194.98 Median $288.40 Typical High $371.54 | Professional | None | $194.98 | $288.40 | $371.54 |
AmeriHealth Setting Facility Modifier None Typical Low $199.53 Median $1,659.59 Typical High $2,454.71 | Facility | None | $199.53 | $1,659.59 | $2,454.71 |
AmeriHealth Setting Professional Modifier None Typical Low $239.88 Median $316.23 Typical High $316.23 | Professional | None | $239.88 | $316.23 | $316.23 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,454.71 Median $2,570.40 Typical High $8,709.64 | Facility | None | $2,454.71 | $2,570.40 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $288.40 Median $295.12 Typical High $562.34 | Professional | None | $288.40 | $295.12 | $562.34 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $229.09 Median $239.88 Typical High $457.09 | Professional | 78 · Unplanned return to OR | $229.09 | $239.88 | $457.09 |
Cigna Setting Facility Modifier None Typical Low $208.93 Median $323.59 Typical High $562.34 | Facility | None | $208.93 | $323.59 | $562.34 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $281.84 Typical High $398.11 | Professional | None | $204.17 | $281.84 | $398.11 |
Emblem Health Setting Professional Modifier None Typical Low $363.08 Median $363.08 Typical High $501.19 | Professional | None | $363.08 | $363.08 | $501.19 |
Geisinger Setting Facility Modifier None Typical Low $190.55 Median $234.42 Typical High $416.87 | Facility | None | $190.55 | $234.42 | $416.87 |
Geisinger Setting Professional Modifier None Typical Low $302.00 Median $389.05 Typical High $630.96 | Professional | None | $302.00 | $389.05 | $630.96 |
Highmark BCBS Setting Facility Modifier None Typical Low $218.78 Median $288.40 Typical High $1,047.13 | Facility | None | $218.78 | $288.40 | $1,047.13 |
Highmark BCBS Setting Professional Modifier None Typical Low $263.03 Median $346.74 Typical High $371.54 | Professional | None | $263.03 | $346.74 | $371.54 |
Independence Blue Cross Setting Facility Modifier None Typical Low $199.53 Median $1,548.82 Typical High $2,344.23 | Facility | None | $199.53 | $1,548.82 | $2,344.23 |
Independence Blue Cross Setting Professional Modifier None Typical Low $239.88 Median $316.23 Typical High $316.23 | Professional | None | $239.88 | $316.23 | $316.23 |
Martin's Point Setting Facility Modifier None Typical Low $478.63 Median $2,137.96 Typical High $7,244.36 | Facility | None | $478.63 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $223.87 Median $288.40 Typical High $346.74 | Professional | None | $223.87 | $288.40 | $346.74 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $158.49 Median $199.53 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $158.49 | $199.53 | $229.09 |
Oscar Health Setting Facility Modifier None Typical Low $234.42 Median $1,000.00 Typical High $1,000.00 | Facility | None | $234.42 | $1,000.00 | $1,000.00 |
Oscar Health Setting Professional Modifier None Typical Low $416.87 Median $416.87 Typical High $446.68 | Professional | None | $416.87 | $416.87 | $446.68 |
UPMC Health Plan Setting Facility Modifier None Typical Low $288.40 Median $812.83 Typical High $1,862.09 | Facility | None | $288.40 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $223.87 Median $346.74 Typical High $380.19 | Professional | None | $223.87 | $346.74 | $380.19 |
United Setting Facility Modifier None Typical Low $199.53 Median $436.52 Typical High $1,862.09 | Facility | None | $199.53 | $436.52 | $1,862.09 |
United Setting Professional Modifier None Typical Low $223.87 Median $309.03 Typical High $478.63 | Professional | None | $223.87 | $309.03 | $478.63 |
12 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 $112.20 Median $141.25 Typical High $162.18 | Professional | 52 · Reduced service | $112.20 | $141.25 | $162.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $57.54 Typical High $64.57 | Professional | 53 · Discontinued | $45.71 | $57.54 | $64.57 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $169.82 Median $213.80 Typical High $245.47 | Professional | 54 · Surgery only | $169.82 | $213.80 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $42.66 Typical High $48.98 | Professional | 55 · Aftercare only | $33.88 | $42.66 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.39 Median $28.84 Typical High $32.36 | Professional | 56 · Pre-op care only | $22.39 | $28.84 | $32.36 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $426.58 Median $446.68 Typical High $851.14 | Professional | 50 · Both sides | $426.58 | $446.68 | $851.14 |
Highmark BCBS Setting Professional Modifier 79 · Unrelated procedure after surgery Typical Low $288.40 Median $363.08 Typical High $363.08 | Professional | 79 · Unrelated procedure after surgery | $288.40 | $363.08 | $363.08 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $112.20 Median $141.25 Typical High $162.18 | Professional | 52 · Reduced service | $112.20 | $141.25 | $162.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $57.54 Typical High $64.57 | Professional | 53 · Discontinued | $45.71 | $57.54 | $64.57 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $169.82 Median $213.80 Typical High $245.47 | Professional | 54 · Surgery only | $169.82 | $213.80 | $245.47 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $42.66 Typical High $48.98 | Professional | 55 · Aftercare only | $33.88 | $42.66 | $48.98 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $22.39 Median $28.84 Typical High $32.36 | Professional | 56 · Pre-op care only | $22.39 | $28.84 | $32.36 |
Where Pennsylvania sits
The same service costs 4.2 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· 46th of 51
$295
AK $955UT $229
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.