How much rates vary
Facilitymedian $447 · 10th to 90th $102 to $3,715Professionalmedian $309 · 10th to 90th $191 to $468
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 $295.12 Median $1,513.56 Typical High $7,585.78 | Facility | None | $295.12 | $1,513.56 | $7,585.78 |
Aetna Setting Professional Modifier None Typical Low $190.55 Median $316.23 Typical High $363.08 | Professional | None | $190.55 | $316.23 | $363.08 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $131.83 Median $190.55 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $131.83 | $190.55 | $251.19 |
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 $239.88 Median $436.52 Typical High $794.33 | Facility | None | $239.88 | $436.52 | $794.33 |
Cigna Setting Professional Modifier None Typical Low $199.53 Median $302.00 Typical High $489.78 | Professional | None | $199.53 | $302.00 | $489.78 |
Emblem Health Setting Professional Modifier None Typical Low $676.08 Median $676.08 Typical High $676.08 | Professional | None | $676.08 | $676.08 | $676.08 |
Geisinger Setting Facility Modifier None Typical Low $218.78 Median $269.15 Typical High $478.63 | Facility | None | $218.78 | $269.15 | $478.63 |
Geisinger Setting Professional Modifier None Typical Low $263.03 Median $436.52 Typical High $645.65 | Professional | None | $263.03 | $436.52 | $645.65 |
Highmark BCBS Setting Facility Modifier None Typical Low $758.58 Median $1,348.96 Typical High $2,511.89 | Facility | None | $758.58 | $1,348.96 | $2,511.89 |
Highmark BCBS Setting Professional Modifier None Typical Low $239.88 Median $380.19 Typical High $512.86 | Professional | None | $239.88 | $380.19 | $512.86 |
Martin's Point Setting Facility Modifier None Typical Low $331.13 Median $1,584.89 Typical High $7,244.36 | Facility | None | $331.13 | $1,584.89 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $190.55 Median $323.59 Typical High $363.08 | Professional | None | $190.55 | $323.59 | $363.08 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $131.83 Median $190.55 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $131.83 | $190.55 | $251.19 |
Oscar Health Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $691.83 | Professional | None | $309.03 | $309.03 | $691.83 |
UPMC Health Plan Setting Facility Modifier None Typical Low $199.53 Median $1,071.52 Typical High $2,511.89 | Facility | None | $199.53 | $1,071.52 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $199.53 Median $309.03 Typical High $371.54 | Professional | None | $199.53 | $309.03 | $371.54 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,348.96 | Facility | None | $77.62 | $158.49 | $1,348.96 |
United Setting Professional Modifier None Typical Low $199.53 Median $331.13 Typical High $524.81 | Professional | None | $199.53 | $331.13 | $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 $95.50 Median $134.90 Typical High $177.83 | Professional | 52 · Reduced service | $95.50 | $134.90 | $177.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $53.70 Typical High $72.44 | Professional | 53 · Discontinued | $38.02 | $53.70 | $72.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $204.17 Typical High $269.15 | Professional | 54 · Surgery only | $141.25 | $204.17 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $40.74 Typical High $53.70 | Professional | 55 · Aftercare only | $28.18 | $40.74 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $26.92 Typical High $36.31 | Professional | 56 · Pre-op care only | $19.05 | $26.92 | $36.31 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $95.50 Median $134.90 Typical High $177.83 | Professional | 52 · Reduced service | $95.50 | $134.90 | $177.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $53.70 Typical High $72.44 | Professional | 53 · Discontinued | $38.02 | $53.70 | $72.44 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $204.17 Typical High $269.15 | Professional | 54 · Surgery only | $141.25 | $204.17 | $269.15 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $40.74 Typical High $53.70 | Professional | 55 · Aftercare only | $28.18 | $40.74 | $53.70 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $26.92 Typical High $36.31 | Professional | 56 · Pre-op care only | $19.05 | $26.92 | $36.31 |
Where Pennsylvania sits
The same service costs 3.5 times more in Alaska than in Maryland. 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
$331
AK $891MD $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.