How much rates vary
Facilitymedian $380 · 10th to 90th $100 to $3,020Professionalmedian $309 · 10th to 90th $240 to $550
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 $309.03 Median $2,137.96 Typical High $8,317.64 | Facility | None | $309.03 | $2,137.96 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $234.42 Median $295.12 Typical High $407.38 | Professional | None | $234.42 | $295.12 | $407.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $204.17 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $165.96 | $204.17 | $218.78 |
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 $338.84 Median $354.81 Typical High $812.83 | Professional | None | $338.84 | $354.81 | $812.83 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $239.88 Median $251.19 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $239.88 | $251.19 | $575.44 |
Cigna Setting Facility Modifier None Typical Low $223.87 Median $346.74 Typical High $575.44 | Facility | None | $223.87 | $346.74 | $575.44 |
Cigna Setting Professional Modifier None Typical Low $251.19 Median $323.59 Typical High $524.81 | Professional | None | $251.19 | $323.59 | $524.81 |
Emblem Health Setting Professional Modifier None Typical Low $575.44 Median $575.44 Typical High $575.44 | Professional | None | $575.44 | $575.44 | $575.44 |
Geisinger Setting Facility Modifier None Typical Low $204.17 Median $251.19 Typical High $446.68 | Facility | None | $204.17 | $251.19 | $446.68 |
Geisinger Setting Professional Modifier None Typical Low $316.23 Median $446.68 Typical High $630.96 | Professional | None | $316.23 | $446.68 | $630.96 |
Highmark BCBS Setting Facility Modifier None Typical Low $912.01 Median $1,230.27 Typical High $5,370.32 | Facility | None | $912.01 | $1,230.27 | $5,370.32 |
Martin's Point Setting Facility Modifier None Typical Low $457.09 Median $2,137.96 Typical High $7,244.36 | Facility | None | $457.09 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $234.42 Median $295.12 Typical High $380.19 | Professional | None | $234.42 | $295.12 | $380.19 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $204.17 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $165.96 | $204.17 | $218.78 |
Oscar Health Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $676.08 | Professional | None | $323.59 | $323.59 | $676.08 |
UPMC Health Plan Setting Facility Modifier None Typical Low $281.84 Median $501.19 Typical High $1,148.15 | Facility | None | $281.84 | $501.19 | $1,148.15 |
UPMC Health Plan Setting Professional Modifier None Typical Low $269.15 Median $323.59 Typical High $346.74 | Professional | None | $269.15 | $323.59 | $346.74 |
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 $245.47 Median $316.23 Typical High $562.34 | Professional | None | $245.47 | $316.23 | $562.34 |
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 $117.49 Median $147.91 Typical High $154.88 | Professional | 52 · Reduced service | $117.49 | $147.91 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $58.88 Typical High $63.10 | Professional | 53 · Discontinued | $46.77 | $58.88 | $63.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $177.83 Median $218.78 Typical High $234.42 | Professional | 54 · Surgery only | $177.83 | $218.78 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $44.67 Typical High $46.77 | Professional | 55 · Aftercare only | $35.48 | $44.67 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $29.51 Typical High $30.90 | Professional | 56 · Pre-op care only | $23.44 | $29.51 | $30.90 |
Highmark BCBS Setting Professional Modifier 58 · Staged procedure Typical Low $323.59 Median $346.74 Typical High $478.63 | Professional | 58 · Staged procedure | $323.59 | $346.74 | $478.63 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $117.49 Median $147.91 Typical High $154.88 | Professional | 52 · Reduced service | $117.49 | $147.91 | $154.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $58.88 Typical High $63.10 | Professional | 53 · Discontinued | $46.77 | $58.88 | $63.10 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $177.83 Median $218.78 Typical High $234.42 | Professional | 54 · Surgery only | $177.83 | $218.78 | $234.42 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $44.67 Typical High $46.77 | Professional | 55 · Aftercare only | $35.48 | $44.67 | $46.77 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $29.51 Typical High $30.90 | Professional | 56 · Pre-op care only | $23.44 | $29.51 | $30.90 |
Where Pennsylvania sits
The same service costs 4.7 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· 43rd of 51
$316
AK $1,122TX $240
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.