How much rates vary
Facilitymedian $1,585 · 10th to 90th $708 to $5,495Professionalmedian $912 · 10th to 90th $794 to $1,585
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 $831.76 Median $3,801.89 Typical High $8,317.64 | Facility | None | $831.76 | $3,801.89 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $794.33 Median $831.76 Typical High $977.24 | Professional | None | $794.33 | $831.76 | $977.24 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $588.84 Typical High $588.84 | Professional | 78 · Unplanned return to OR | $562.34 | $588.84 | $588.84 |
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 $933.25 Median $954.99 Typical High $2,187.76 | Professional | None | $933.25 | $954.99 | $2,187.76 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $676.08 Typical High $1,584.89 | Professional | 78 · Unplanned return to OR | $660.69 | $676.08 | $1,584.89 |
Cigna Setting Facility Modifier None Typical Low $524.81 Median $1,202.26 Typical High $2,290.87 | Facility | None | $524.81 | $1,202.26 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $812.83 Median $851.14 Typical High $1,584.89 | Professional | None | $812.83 | $851.14 | $1,584.89 |
Emblem Health Setting Professional Modifier None Typical Low $1,445.44 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,445.44 | $1,445.44 | $1,445.44 |
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 $776.25 Median $1,122.02 Typical High $1,778.28 | Professional | None | $776.25 | $1,122.02 | $1,778.28 |
Highmark BCBS Setting Facility Modifier None Typical Low $13,489.63 Median $13,489.63 Typical High $16,982.44 | Facility | None | $13,489.63 | $13,489.63 | $16,982.44 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $3,715.35 Typical High $8,317.64 | Facility | None | $831.76 | $3,715.35 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $794.33 Median $831.76 Typical High $977.24 | Professional | None | $794.33 | $831.76 | $977.24 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $588.84 Typical High $588.84 | Professional | 78 · Unplanned return to OR | $562.34 | $588.84 | $588.84 |
Oscar Health Setting Professional Modifier None Typical Low $912.01 Median $912.01 Typical High $1,737.80 | Professional | None | $912.01 | $912.01 | $1,737.80 |
UPMC Health Plan Setting Facility Modifier None Typical Low $891.25 Median $2,511.89 Typical High $4,897.79 | Facility | None | $891.25 | $2,511.89 | $4,897.79 |
UPMC Health Plan Setting Professional Modifier None Typical Low $891.25 Median $912.01 Typical High $912.01 | Professional | None | $891.25 | $912.01 | $912.01 |
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 $776.25 Median $933.25 Typical High $1,737.80 | Professional | None | $776.25 | $933.25 | $1,737.80 |
11 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 $398.11 Median $416.87 Typical High $416.87 | Professional | 52 · Reduced service | $398.11 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $165.96 Typical High $165.96 | Professional | 53 · Discontinued | $158.49 | $165.96 | $165.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $630.96 Typical High $630.96 | Professional | 54 · Surgery only | $602.56 | $630.96 | $630.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $125.89 Typical High $125.89 | Professional | 55 · Aftercare only | $120.23 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $83.18 Typical High $83.18 | Professional | 56 · Pre-op care only | $79.43 | $83.18 | $83.18 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,380.38 Median $1,445.44 Typical High $3,311.31 | Professional | 50 · Both sides | $1,380.38 | $1,445.44 | $3,311.31 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $398.11 Median $416.87 Typical High $416.87 | Professional | 52 · Reduced service | $398.11 | $416.87 | $416.87 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $165.96 Typical High $165.96 | Professional | 53 · Discontinued | $158.49 | $165.96 | $165.96 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $630.96 Typical High $630.96 | Professional | 54 · Surgery only | $602.56 | $630.96 | $630.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $125.89 Typical High $125.89 | Professional | 55 · Aftercare only | $120.23 | $125.89 | $125.89 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $83.18 Typical High $83.18 | Professional | 56 · Pre-op care only | $79.43 | $83.18 | $83.18 |
Where Pennsylvania sits
The same service costs 3.5 times more in Wisconsin 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.
Physician feeFacility fee
WI $7,760MD $2,222
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.