How much rates vary
Facilitymedian $575 · 10th to 90th $100 to $3,802Professionalmedian $288 · 10th to 90th $182 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 $354.81 Median $2,570.40 Typical High $8,317.64 | Facility | None | $354.81 | $2,570.40 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $181.97 Median $309.03 Typical High $389.05 | Professional | None | $181.97 | $309.03 | $389.05 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $128.82 Median $181.97 Typical High $245.47 | Professional | 78 · Unplanned return to OR | $128.82 | $181.97 | $245.47 |
Capital Blue Cross Setting Facility Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $56,234.13 | Facility | None | $1,202.26 | $1,412.54 | $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 $295.12 Median $309.03 Typical High $676.08 | Professional | 78 · Unplanned return to OR | $295.12 | $309.03 | $676.08 |
Cigna Setting Facility Modifier None Typical Low $407.38 Median $575.44 Typical High $891.25 | Facility | None | $407.38 | $575.44 | $891.25 |
Cigna Setting Professional Modifier None Typical Low $186.21 Median $288.40 Typical High $478.63 | Professional | None | $186.21 | $288.40 | $478.63 |
Emblem Health Setting Professional Modifier None Typical Low $660.69 Median $660.69 Typical High $660.69 | Professional | None | $660.69 | $660.69 | $660.69 |
Geisinger Setting Facility Modifier None Typical Low $389.05 Median $489.78 Typical High $870.96 | Facility | None | $389.05 | $489.78 | $870.96 |
Geisinger Setting Professional Modifier None Typical Low $245.47 Median $426.58 Typical High $645.65 | Professional | None | $245.47 | $426.58 | $645.65 |
Highmark BCBS Setting Facility Modifier None Typical Low $380.19 Median $1,023.29 Typical High $2,951.21 | Facility | None | $380.19 | $1,023.29 | $2,951.21 |
Highmark BCBS Setting Professional Modifier None Typical Low $371.54 Median $380.19 Typical High $389.05 | Professional | None | $371.54 | $380.19 | $389.05 |
Martin's Point Setting Facility Modifier None Typical Low $354.81 Median $2,454.71 Typical High $8,317.64 | Facility | None | $354.81 | $2,454.71 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $181.97 Median $309.03 Typical High $389.05 | Professional | None | $181.97 | $309.03 | $389.05 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $128.82 Median $181.97 Typical High $245.47 | Professional | 78 · Unplanned return to OR | $128.82 | $181.97 | $245.47 |
Oscar Health Setting Professional Modifier None Typical Low $275.42 Median $275.42 Typical High $660.69 | Professional | None | $275.42 | $275.42 | $660.69 |
UPMC Health Plan Setting Facility Modifier None Typical Low $199.53 Median $1,096.48 Typical High $2,511.89 | Facility | None | $199.53 | $1,096.48 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $199.53 Median $275.42 Typical High $371.54 | Professional | None | $199.53 | $275.42 | $371.54 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,819.70 | Facility | None | $77.62 | $158.49 | $1,819.70 |
United Setting Professional Modifier None Typical Low $194.98 Median $331.13 Typical High $512.86 | Professional | None | $194.98 | $331.13 | $512.86 |
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 $91.20 Median $128.82 Typical High $177.83 | Professional | 52 · Reduced service | $91.20 | $128.82 | $177.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $51.29 Typical High $70.79 | Professional | 53 · Discontinued | $37.15 | $51.29 | $70.79 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $194.98 Typical High $263.03 | Professional | 54 · Surgery only | $138.04 | $194.98 | $263.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $38.90 Typical High $53.70 | Professional | 55 · Aftercare only | $27.54 | $38.90 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $25.70 Typical High $35.48 | Professional | 56 · Pre-op care only | $18.20 | $25.70 | $35.48 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $91.20 Median $128.82 Typical High $177.83 | Professional | 52 · Reduced service | $91.20 | $128.82 | $177.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $51.29 Typical High $70.79 | Professional | 53 · Discontinued | $37.15 | $51.29 | $70.79 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $194.98 Typical High $263.03 | Professional | 54 · Surgery only | $138.04 | $194.98 | $263.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $38.90 Typical High $53.70 | Professional | 55 · Aftercare only | $27.54 | $38.90 | $53.70 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $25.70 Typical High $35.48 | Professional | 56 · Pre-op care only | $18.20 | $25.70 | $35.48 |
Where Pennsylvania sits
The same service costs 3.4 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· 36th of 51
$331
AK $871KY $257
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.