How much rates vary
Facilitymedian $166 · 10th to 90th $78 to $3,020Professionalmedian $141 · 10th to 90th $105 to $191
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 $162.18 Median $2,344.23 Typical High $8,317.64 | Facility | None | $162.18 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $112.20 Median $141.25 Typical High $169.82 | Professional | None | $112.20 | $141.25 | $169.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $100.00 Typical High $112.20 | Professional | 78 · Unplanned return to OR | $79.43 | $100.00 | $112.20 |
Ambetter Setting Professional Modifier None Typical Low $77.62 Median $134.90 Typical High $154.88 | Professional | None | $77.62 | $134.90 | $154.88 |
AmeriHealth Setting Professional Modifier None Typical Low $77.62 Median $154.88 Typical High $154.88 | Professional | None | $77.62 | $154.88 | $154.88 |
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 $141.25 Median $144.54 Typical High $245.47 | Professional | None | $141.25 | $144.54 | $245.47 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $112.20 Median $114.82 Typical High $194.98 | Professional | 78 · Unplanned return to OR | $112.20 | $114.82 | $194.98 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $107.15 Typical High $194.98 | Facility | None | $50.12 | $107.15 | $194.98 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $128.82 Typical High $186.21 | Professional | None | $97.72 | $128.82 | $186.21 |
Emblem Health Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $239.88 | Professional | None | $173.78 | $173.78 | $239.88 |
Geisinger Setting Facility Modifier None Typical Low $93.33 Median $117.49 Typical High $204.17 | Facility | None | $93.33 | $117.49 | $204.17 |
Geisinger Setting Professional Modifier None Typical Low $109.65 Median $147.91 Typical High $245.47 | Professional | None | $109.65 | $147.91 | $245.47 |
Highmark BCBS Setting Facility Modifier None Typical Low $426.58 Median $776.25 Typical High $1,513.56 | Facility | None | $426.58 | $776.25 | $1,513.56 |
Highmark BCBS Setting Professional Modifier None Typical Low $162.18 Median $177.83 Typical High $245.47 | Professional | None | $162.18 | $177.83 | $245.47 |
Independence Blue Cross Setting Professional Modifier None Typical Low $77.62 Median $147.91 Typical High $154.88 | Professional | None | $77.62 | $147.91 | $154.88 |
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 $112.20 Median $141.25 Typical High $169.82 | Professional | None | $112.20 | $141.25 | $169.82 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $100.00 Typical High $112.20 | Professional | 78 · Unplanned return to OR | $79.43 | $100.00 | $112.20 |
Oscar Health Setting Professional Modifier None Typical Low $288.40 Median $288.40 Typical High $288.40 | Professional | None | $288.40 | $288.40 | $288.40 |
UPMC Health Plan Setting Facility Modifier None Typical Low $141.25 Median $204.17 Typical High $457.09 | Facility | None | $141.25 | $204.17 | $457.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $112.20 Median $165.96 Typical High $204.17 | Professional | None | $112.20 | $165.96 | $204.17 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,230.27 | Facility | None | $77.62 | $158.49 | $1,230.27 |
United Setting Professional Modifier None Typical Low $104.71 Median $138.04 Typical High $213.80 | Professional | None | $104.71 | $138.04 | $213.80 |
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 $56.23 Median $70.79 Typical High $81.28 | Professional | 52 · Reduced service | $56.23 | $70.79 | $81.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.39 Median $28.18 Typical High $32.36 | Professional | 53 · Discontinued | $22.39 | $28.18 | $32.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $107.15 Typical High $120.23 | Professional | 54 · Surgery only | $85.11 | $107.15 | $120.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $21.38 Typical High $23.99 | Professional | 55 · Aftercare only | $16.98 | $21.38 | $23.99 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.22 Median $14.13 Typical High $16.22 | Professional | 56 · Pre-op care only | $11.22 | $14.13 | $16.22 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $208.93 Median $218.78 Typical High $363.08 | Professional | 50 · Both sides | $208.93 | $218.78 | $363.08 |
Highmark BCBS Setting Professional Modifier 50 · Both sides Typical Low $239.88 Median $263.03 Typical High $288.40 | Professional | 50 · Both sides | $239.88 | $263.03 | $288.40 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $56.23 Median $70.79 Typical High $81.28 | Professional | 52 · Reduced service | $56.23 | $70.79 | $81.28 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $22.39 Median $28.18 Typical High $32.36 | Professional | 53 · Discontinued | $22.39 | $28.18 | $32.36 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $107.15 Typical High $120.23 | Professional | 54 · Surgery only | $85.11 | $107.15 | $120.23 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $21.38 Typical High $23.99 | Professional | 55 · Aftercare only | $16.98 | $21.38 | $23.99 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $11.22 Median $14.13 Typical High $16.22 | Professional | 56 · Pre-op care only | $11.22 | $14.13 | $16.22 |
Where Pennsylvania sits
The same service costs 4.1 times more in Alaska than in Florida. 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· 40th of 51
$141
AK $468FL $115
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.