How much rates vary
Facilitymedian $575 · 10th to 90th $219 to $3,890Professionalmedian $263 · 10th to 90th $148 to $339
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 $316.23 Median $2,951.21 Typical High $8,511.38 | Facility | None | $316.23 | $2,951.21 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $151.36 Median $263.03 Typical High $323.59 | Professional | None | $151.36 | $263.03 | $323.59 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $151.36 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $104.71 | $151.36 | $218.78 |
Ambetter Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $245.47 | Professional | None | $120.23 | $120.23 | $245.47 |
AmeriHealth Setting Facility Modifier None Typical Low $562.34 Median $707.95 Typical High $10,715.19 | Facility | None | $562.34 | $707.95 | $10,715.19 |
AmeriHealth Setting Professional Modifier None Typical Low $162.18 Median $302.00 Typical High $302.00 | Professional | None | $162.18 | $302.00 | $302.00 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,630.27 Median $2,818.38 Typical High $8,709.64 | Facility | None | $2,630.27 | $2,818.38 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $263.03 Median $275.42 Typical High $501.19 | Professional | None | $263.03 | $275.42 | $501.19 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $213.80 Median $218.78 Typical High $407.38 | Professional | 78 · Unplanned return to OR | $213.80 | $218.78 | $407.38 |
Cigna Setting Facility Modifier None Typical Low $218.78 Median $338.84 Typical High $562.34 | Facility | None | $218.78 | $338.84 | $562.34 |
Cigna Setting Professional Modifier None Typical Low $131.83 Median $223.87 Typical High $316.23 | Professional | None | $131.83 | $223.87 | $316.23 |
Emblem Health Setting Professional Modifier None Typical Low $338.84 Median $338.84 Typical High $467.74 | Professional | None | $338.84 | $338.84 | $467.74 |
Geisinger Setting Facility Modifier None Typical Low $199.53 Median $251.19 Typical High $436.52 | Facility | None | $199.53 | $251.19 | $436.52 |
Geisinger Setting Professional Modifier None Typical Low $154.88 Median $302.00 Typical High $467.74 | Professional | None | $154.88 | $302.00 | $467.74 |
Highmark BCBS Setting Facility Modifier None Typical Low $147.91 Median $302.00 Typical High $4,570.88 | Facility | None | $147.91 | $302.00 | $4,570.88 |
Highmark BCBS Setting Professional Modifier None Typical Low $181.97 Median $309.03 Typical High $338.84 | Professional | None | $181.97 | $309.03 | $338.84 |
Independence Blue Cross Setting Professional Modifier None Typical Low $162.18 Median $269.15 Typical High $302.00 | Professional | None | $162.18 | $269.15 | $302.00 |
Martin's Point Setting Facility Modifier None Typical Low $537.03 Median $2,630.27 Typical High $8,317.64 | Facility | None | $537.03 | $2,630.27 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $151.36 Median $251.19 Typical High $316.23 | Professional | None | $151.36 | $251.19 | $316.23 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $151.36 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $104.71 | $151.36 | $218.78 |
Oscar Health Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $323.59 | Professional | None | $309.03 | $309.03 | $323.59 |
UPMC Health Plan Setting Facility Modifier None Typical Low $181.97 Median $1,548.82 Typical High $3,548.13 | Facility | None | $181.97 | $1,548.82 | $3,548.13 |
UPMC Health Plan Setting Professional Modifier None Typical Low $151.36 Median $269.15 Typical High $562.34 | Professional | None | $151.36 | $269.15 | $562.34 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $2,630.27 | Facility | None | $416.87 | $724.44 | $2,630.27 |
United Setting Professional Modifier None Typical Low $141.25 Median $245.47 Typical High $346.74 | Professional | None | $141.25 | $245.47 | $346.74 |
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 $75.86 Median $107.15 Typical High $158.49 | Professional | 52 · Reduced service | $75.86 | $107.15 | $158.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $43.65 Typical High $63.10 | Professional | 53 · Discontinued | $30.20 | $43.65 | $63.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $162.18 Typical High $234.42 | Professional | 54 · Surgery only | $112.20 | $162.18 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $32.36 Typical High $46.77 | Professional | 55 · Aftercare only | $22.39 | $32.36 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $21.88 Typical High $31.62 | Professional | 56 · Pre-op care only | $15.14 | $21.88 | $31.62 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $398.11 Median $416.87 Typical High $758.58 | Professional | 50 · Both sides | $398.11 | $416.87 | $758.58 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $75.86 Median $107.15 Typical High $158.49 | Professional | 52 · Reduced service | $75.86 | $107.15 | $158.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $43.65 Typical High $63.10 | Professional | 53 · Discontinued | $30.20 | $43.65 | $63.10 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $162.18 Typical High $234.42 | Professional | 54 · Surgery only | $112.20 | $162.18 | $234.42 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $32.36 Typical High $46.77 | Professional | 55 · Aftercare only | $22.39 | $32.36 | $46.77 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $21.88 Typical High $31.62 | Professional | 56 · Pre-op care only | $15.14 | $21.88 | $31.62 |
Where Pennsylvania sits
The same service costs 3.8 times more in Wyoming 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
$263
WY $741KY $195
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.