How much rates vary
Facilitymedian $933 · 10th to 90th $417 to $4,365Professionalmedian $295 · 10th to 90th $204 to $447
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 $309.03 Median $2,630.27 Typical High $8,317.64 | Facility | None | $309.03 | $2,630.27 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $204.17 Median $295.12 Typical High $371.54 | Professional | None | $204.17 | $295.12 | $371.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $144.54 Median $190.55 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $144.54 | $190.55 | $218.78 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $56,234.13 | Facility | None | $3,981.07 | $4,365.16 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $56,234.13 Median $56,234.13 Typical High $56,234.13 | Professional | None | $56,234.13 | $56,234.13 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $263.03 Median $275.42 Typical High $645.65 | Professional | 78 · Unplanned return to OR | $263.03 | $275.42 | $645.65 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $776.25 Typical High $1,445.44 | Facility | None | $478.63 | $776.25 | $1,445.44 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $288.40 Typical High $457.09 | Professional | None | $204.17 | $288.40 | $457.09 |
Emblem Health Setting Professional Modifier None Typical Low $575.44 Median $575.44 Typical High $575.44 | Professional | None | $575.44 | $575.44 | $575.44 |
Geisinger Setting Facility Modifier None Typical Low $724.44 Median $891.25 Typical High $1,584.89 | Facility | None | $724.44 | $891.25 | $1,584.89 |
Geisinger Setting Professional Modifier None Typical Low $251.19 Median $389.05 Typical High $562.34 | Professional | None | $251.19 | $389.05 | $562.34 |
Highmark BCBS Setting Facility Modifier None Typical Low $478.63 Median $3,630.78 Typical High $7,079.46 | Facility | None | $478.63 | $3,630.78 | $7,079.46 |
Highmark BCBS Setting Professional Modifier None Typical Low $234.42 Median $309.03 Typical High $331.13 | Professional | None | $234.42 | $309.03 | $331.13 |
Martin's Point Setting Facility Modifier None Typical Low $309.03 Median $2,570.40 Typical High $8,317.64 | Facility | None | $309.03 | $2,570.40 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $204.17 Median $295.12 Typical High $371.54 | Professional | None | $204.17 | $295.12 | $371.54 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $144.54 Median $190.55 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $144.54 | $190.55 | $218.78 |
Oscar Health Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $645.65 | Professional | None | $309.03 | $309.03 | $645.65 |
UPMC Health Plan Setting Facility Modifier None Typical Low $218.78 Median $1,071.52 Typical High $2,511.89 | Facility | None | $218.78 | $1,071.52 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $218.78 Median $295.12 Typical High $331.13 | Professional | None | $218.78 | $295.12 | $331.13 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,630.78 | Facility | None | $416.87 | $724.44 | $3,630.78 |
United Setting Professional Modifier None Typical Low $213.80 Median $309.03 Typical High $524.81 | Professional | None | $213.80 | $309.03 | $524.81 |
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 $102.33 Median $134.90 Typical High $154.88 | Professional | 52 · Reduced service | $102.33 | $134.90 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $53.70 Typical High $61.66 | Professional | 53 · Discontinued | $40.74 | $53.70 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $204.17 Typical High $234.42 | Professional | 54 · Surgery only | $154.88 | $204.17 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $40.74 Typical High $46.77 | Professional | 55 · Aftercare only | $30.90 | $40.74 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $26.92 Typical High $30.90 | Professional | 56 · Pre-op care only | $20.42 | $26.92 | $30.90 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $102.33 Median $134.90 Typical High $154.88 | Professional | 52 · Reduced service | $102.33 | $134.90 | $154.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $53.70 Typical High $61.66 | Professional | 53 · Discontinued | $40.74 | $53.70 | $61.66 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $204.17 Typical High $234.42 | Professional | 54 · Surgery only | $154.88 | $204.17 | $234.42 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $40.74 Typical High $46.77 | Professional | 55 · Aftercare only | $30.90 | $40.74 | $46.77 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $26.92 Typical High $30.90 | Professional | 56 · Pre-op care only | $20.42 | $26.92 | $30.90 |
Where Pennsylvania sits
The same service costs 4.0 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· 45th of 51
$309
AK $1,072KY $269
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.