How much rates vary
Facilitymedian $1,514 · 10th to 90th $479 to $5,370Professionalmedian $355 · 10th to 90th $251 to $562
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 $371.54 Median $2,630.27 Typical High $8,317.64 | Facility | None | $371.54 | $2,630.27 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $251.19 Median $354.81 Typical High $489.78 | Professional | None | $251.19 | $354.81 | $489.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $234.42 Typical High $263.03 | Professional | 78 · Unplanned return to OR | $177.83 | $234.42 | $263.03 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $6,025.60 Typical High $56,234.13 | Facility | None | $3,981.07 | $6,025.60 | $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 $316.23 Median $331.13 Typical High $776.25 | Professional | 78 · Unplanned return to OR | $316.23 | $331.13 | $776.25 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $1,202.26 Typical High $2,041.74 | Facility | None | $478.63 | $1,202.26 | $2,041.74 |
Cigna Setting Professional Modifier None Typical Low $263.03 Median $363.08 Typical High $575.44 | Professional | None | $263.03 | $363.08 | $575.44 |
Emblem Health Setting Professional Modifier None Typical Low $724.44 Median $724.44 Typical High $724.44 | Professional | None | $724.44 | $724.44 | $724.44 |
Geisinger Setting Facility Modifier None Typical Low $1,202.26 Median $1,513.56 Typical High $2,630.27 | Facility | None | $1,202.26 | $1,513.56 | $2,630.27 |
Geisinger Setting Professional Modifier None Typical Low $338.84 Median $501.19 Typical High $707.95 | Professional | None | $338.84 | $501.19 | $707.95 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,230.27 Median $5,623.41 Typical High $31,622.78 | Facility | None | $1,230.27 | $5,623.41 | $31,622.78 |
Highmark BCBS Setting Professional Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Professional | None | $407.38 | $407.38 | $407.38 |
Martin's Point Setting Facility Modifier None Typical Low $371.54 Median $2,570.40 Typical High $8,317.64 | Facility | None | $371.54 | $2,570.40 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $251.19 Median $354.81 Typical High $489.78 | Professional | None | $251.19 | $354.81 | $489.78 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $234.42 Typical High $263.03 | Professional | 78 · Unplanned return to OR | $177.83 | $234.42 | $263.03 |
Oscar Health Setting Professional Modifier None Typical Low $389.05 Median $389.05 Typical High $776.25 | Professional | None | $389.05 | $389.05 | $776.25 |
UPMC Health Plan Setting Facility Modifier None Typical Low $275.42 Median $1,071.52 Typical High $2,511.89 | Facility | None | $275.42 | $1,071.52 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $275.42 Median $346.74 Typical High $398.11 | Professional | None | $275.42 | $346.74 | $398.11 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,265.80 | Facility | None | $812.83 | $1,318.26 | $4,265.80 |
United Setting Professional Modifier None Typical Low $269.15 Median $380.19 Typical High $645.65 | Professional | None | $269.15 | $380.19 | $645.65 |
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 $125.89 Median $165.96 Typical High $186.21 | Professional | 52 · Reduced service | $125.89 | $165.96 | $186.21 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $50.12 Median $66.07 Typical High $75.86 | Professional | 53 · Discontinued | $50.12 | $66.07 | $75.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $251.19 Typical High $281.84 | Professional | 54 · Surgery only | $190.55 | $251.19 | $281.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $50.12 Typical High $56.23 | Professional | 55 · Aftercare only | $38.02 | $50.12 | $56.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.12 Median $33.11 Typical High $37.15 | Professional | 56 · Pre-op care only | $25.12 | $33.11 | $37.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $125.89 Median $165.96 Typical High $186.21 | Professional | 52 · Reduced service | $125.89 | $165.96 | $186.21 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $50.12 Median $66.07 Typical High $75.86 | Professional | 53 · Discontinued | $50.12 | $66.07 | $75.86 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $251.19 Typical High $281.84 | Professional | 54 · Surgery only | $190.55 | $251.19 | $281.84 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $50.12 Typical High $56.23 | Professional | 55 · Aftercare only | $38.02 | $50.12 | $56.23 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $25.12 Median $33.11 Typical High $37.15 | Professional | 56 · Pre-op care only | $25.12 | $33.11 | $37.15 |
Where Pennsylvania sits
The same service costs 6.1 times more in Colorado than in Montana. 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.
Physician feeFacility fee
CO $6,346MT $1,043
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.