How much rates vary
Facilitymedian $1,585 · 10th to 90th $708 to $5,495Professionalmedian $871 · 10th to 90th $776 to $1,549
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 $812.83 Median $3,801.89 Typical High $8,317.64 | Facility | None | $812.83 | $3,801.89 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $776.25 Median $812.83 Typical High $933.25 | Professional | None | $776.25 | $812.83 | $933.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $575.44 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $537.03 | $575.44 | $575.44 |
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 $891.25 Median $933.25 Typical High $2,137.96 | Professional | None | $891.25 | $933.25 | $2,137.96 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $660.69 Typical High $1,513.56 | Professional | 78 · Unplanned return to OR | $630.96 | $660.69 | $1,513.56 |
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 $776.25 Median $812.83 Typical High $1,513.56 | Professional | None | $776.25 | $812.83 | $1,513.56 |
Emblem Health Setting Professional Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,412.54 | $1,412.54 | $1,412.54 |
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 $741.31 Median $1,096.48 Typical High $1,737.80 | Professional | None | $741.31 | $1,096.48 | $1,737.80 |
Highmark BCBS Setting Facility Modifier None Typical Low $6,309.57 Median $6,309.57 Typical High $15,488.17 | Facility | None | $6,309.57 | $6,309.57 | $15,488.17 |
Martin's Point Setting Facility Modifier None Typical Low $812.83 Median $3,715.35 Typical High $8,317.64 | Facility | None | $812.83 | $3,715.35 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $776.25 Median $812.83 Typical High $933.25 | Professional | None | $776.25 | $812.83 | $933.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $575.44 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $537.03 | $575.44 | $575.44 |
Oscar Health Setting Professional Modifier None Typical Low $812.83 Median $812.83 Typical High $1,621.81 | Professional | None | $812.83 | $812.83 | $1,621.81 |
UPMC Health Plan Setting Facility Modifier None Typical Low $870.96 Median $2,511.89 Typical High $4,897.79 | Facility | None | $870.96 | $2,511.89 | $4,897.79 |
UPMC Health Plan Setting Professional Modifier None Typical Low $870.96 Median $870.96 Typical High $870.96 | Professional | None | $870.96 | $870.96 | $870.96 |
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 $758.58 Median $891.25 Typical High $1,698.24 | Professional | None | $758.58 | $891.25 | $1,698.24 |
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 $389.05 Median $407.38 Typical High $407.38 | Professional | 52 · Reduced service | $389.05 | $407.38 | $407.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $162.18 Typical High $162.18 | Professional | 53 · Discontinued | $154.88 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $575.44 Median $616.60 Typical High $616.60 | Professional | 54 · Surgery only | $575.44 | $616.60 | $616.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $123.03 Typical High $123.03 | Professional | 55 · Aftercare only | $114.82 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $77.62 Median $81.28 Typical High $81.28 | Professional | 56 · Pre-op care only | $77.62 | $81.28 | $81.28 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,348.96 Median $1,380.38 Typical High $3,235.94 | Professional | 50 · Both sides | $1,348.96 | $1,380.38 | $3,235.94 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $389.05 Median $407.38 Typical High $407.38 | Professional | 52 · Reduced service | $389.05 | $407.38 | $407.38 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $162.18 Typical High $162.18 | Professional | 53 · Discontinued | $154.88 | $162.18 | $162.18 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $575.44 Median $616.60 Typical High $616.60 | Professional | 54 · Surgery only | $575.44 | $616.60 | $616.60 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $123.03 Typical High $123.03 | Professional | 55 · Aftercare only | $114.82 | $123.03 | $123.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $77.62 Median $81.28 Typical High $81.28 | Professional | 56 · Pre-op care only | $77.62 | $81.28 | $81.28 |
Where Pennsylvania sits
The same service costs 7.6 times more in Alaska than in Texas. 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· 44th of 51
$891
AK $3,631TX $479
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.