How much rates vary
Facilitymedian $427 · 10th to 90th $141 to $3,890Professionalmedian $174 · 10th to 90th $105 to $240
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 $186.21 Median $2,137.96 Typical High $8,317.64 | Facility | None | $186.21 | $2,137.96 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $173.78 Typical High $213.80 | Professional | None | $104.71 | $173.78 | $213.80 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $97.72 Typical High $128.82 | Professional | 78 · Unplanned return to OR | $74.13 | $97.72 | $128.82 |
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 $190.55 Median $190.55 Typical High $190.55 | Professional | None | $190.55 | $190.55 | $190.55 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $154.88 Median $158.49 Typical High $363.08 | Professional | 78 · Unplanned return to OR | $154.88 | $158.49 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $147.91 Median $323.59 Typical High $549.54 | Facility | None | $147.91 | $323.59 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $162.18 Typical High $251.19 | Professional | None | $97.72 | $162.18 | $251.19 |
Emblem Health Setting Professional Modifier None Typical Low $338.84 Median $338.84 Typical High $338.84 | Professional | None | $338.84 | $338.84 | $338.84 |
Geisinger Setting Facility Modifier None Typical Low $134.90 Median $169.82 Typical High $295.12 | Facility | None | $134.90 | $169.82 | $295.12 |
Geisinger Setting Professional Modifier None Typical Low $138.04 Median $223.87 Typical High $331.13 | Professional | None | $138.04 | $223.87 | $331.13 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,467.37 Median $4,786.30 Typical High $7,585.78 | Facility | None | $3,467.37 | $4,786.30 | $7,585.78 |
Highmark BCBS Setting Professional Modifier None Typical Low $194.98 Median $194.98 Typical High $194.98 | Professional | None | $194.98 | $194.98 | $194.98 |
Martin's Point Setting Facility Modifier None Typical Low $281.84 Median $2,137.96 Typical High $7,244.36 | Facility | None | $281.84 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $104.71 Median $173.78 Typical High $186.21 | Professional | None | $104.71 | $173.78 | $186.21 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $97.72 Typical High $128.82 | Professional | 78 · Unplanned return to OR | $74.13 | $97.72 | $128.82 |
Oscar Health Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $354.81 | Professional | None | $165.96 | $165.96 | $354.81 |
UPMC Health Plan Setting Facility Modifier None Typical Low $89.13 Median $812.83 Typical High $1,862.09 | Facility | None | $89.13 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $89.13 Median $138.04 Typical High $190.55 | Professional | None | $89.13 | $138.04 | $190.55 |
United Setting Facility Modifier None Typical Low $199.53 Median $436.52 Typical High $3,467.37 | Facility | None | $199.53 | $436.52 | $3,467.37 |
United Setting Professional Modifier None Typical Low $109.65 Median $173.78 Typical High $275.42 | Professional | None | $109.65 | $173.78 | $275.42 |
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 $52.48 Median $70.79 Typical High $91.20 | Professional | 52 · Reduced service | $52.48 | $70.79 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $28.18 Typical High $37.15 | Professional | 53 · Discontinued | $20.89 | $28.18 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $104.71 Typical High $138.04 | Professional | 54 · Surgery only | $79.43 | $104.71 | $138.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $21.88 Typical High $27.54 | Professional | 55 · Aftercare only | $15.85 | $21.88 | $27.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $14.79 Typical High $18.62 | Professional | 56 · Pre-op care only | $10.47 | $14.79 | $18.62 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $52.48 Median $70.79 Typical High $91.20 | Professional | 52 · Reduced service | $52.48 | $70.79 | $91.20 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $28.18 Typical High $37.15 | Professional | 53 · Discontinued | $20.89 | $28.18 | $37.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $104.71 Typical High $138.04 | Professional | 54 · Surgery only | $79.43 | $104.71 | $138.04 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $20.89 Typical High $27.54 | Professional | 55 · Aftercare only | $15.85 | $20.89 | $27.54 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $14.13 Typical High $18.62 | Professional | 56 · Pre-op care only | $10.47 | $14.13 | $18.62 |
Where Pennsylvania sits
The same service costs 3.6 times more in Alaska 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· 39th of 51
$178
AK $501KY $138
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.