How much rates vary
Facilitymedian $316 · 10th to 90th $100 to $3,802Professionalmedian $204 · 10th to 90th $132 to $295
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 $213.80 Median $3,090.30 Typical High $8,511.38 | Facility | None | $213.80 | $3,090.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $204.17 Typical High $229.09 | Professional | None | $131.83 | $204.17 | $229.09 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $125.89 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $91.20 | $125.89 | $151.36 |
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 $186.21 Median $190.55 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $186.21 | $190.55 | $436.52 |
Cigna Setting Facility Modifier None Typical Low $154.88 Median $323.59 Typical High $549.54 | Facility | None | $154.88 | $323.59 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $199.53 Typical High $309.03 | Professional | None | $134.90 | $199.53 | $309.03 |
Emblem Health Setting Professional Modifier None Typical Low $389.05 Median $389.05 Typical High $389.05 | Professional | None | $389.05 | $389.05 | $389.05 |
Geisinger Setting Facility Modifier None Typical Low $141.25 Median $177.83 Typical High $309.03 | Facility | None | $141.25 | $177.83 | $309.03 |
Geisinger Setting Professional Modifier None Typical Low $181.97 Median $269.15 Typical High $380.19 | Professional | None | $181.97 | $269.15 | $380.19 |
Highmark BCBS Setting Facility Modifier None Typical Low $891.25 Median $891.25 Typical High $891.25 | Facility | None | $891.25 | $891.25 | $891.25 |
Highmark BCBS Setting Professional Modifier None Typical Low $151.36 Median $234.42 Typical High $234.42 | Professional | None | $151.36 | $234.42 | $234.42 |
Martin's Point Setting Facility Modifier None Typical Low $575.44 Median $2,691.53 Typical High $8,317.64 | Facility | None | $575.44 | $2,691.53 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $131.83 Median $204.17 Typical High $213.80 | Professional | None | $131.83 | $204.17 | $213.80 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $125.89 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $91.20 | $125.89 | $151.36 |
Oscar Health Setting Professional Modifier None Typical Low $213.80 Median $213.80 Typical High $446.68 | Professional | None | $213.80 | $213.80 | $446.68 |
UPMC Health Plan Setting Facility Modifier None Typical Low $158.49 Median $234.42 Typical High $457.09 | Facility | None | $158.49 | $234.42 | $457.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $147.91 Median $223.87 Typical High $234.42 | Professional | None | $147.91 | $223.87 | $234.42 |
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 $141.25 Median $208.93 Typical High $338.84 | Professional | None | $141.25 | $208.93 | $338.84 |
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 $66.07 Median $89.13 Typical High $107.15 | Professional | 52 · Reduced service | $66.07 | $89.13 | $107.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $36.31 Typical High $43.65 | Professional | 53 · Discontinued | $26.30 | $36.31 | $43.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $134.90 Typical High $162.18 | Professional | 54 · Surgery only | $97.72 | $134.90 | $162.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $26.92 Typical High $32.36 | Professional | 55 · Aftercare only | $19.50 | $26.92 | $32.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $18.20 Typical High $21.38 | Professional | 56 · Pre-op care only | $13.18 | $18.20 | $21.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $66.07 Median $89.13 Typical High $107.15 | Professional | 52 · Reduced service | $66.07 | $89.13 | $107.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $36.31 Typical High $43.65 | Professional | 53 · Discontinued | $26.30 | $36.31 | $43.65 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $134.90 Typical High $162.18 | Professional | 54 · Surgery only | $97.72 | $134.90 | $162.18 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $26.92 Typical High $32.36 | Professional | 55 · Aftercare only | $19.50 | $26.92 | $32.36 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $18.20 Typical High $21.38 | Professional | 56 · Pre-op care only | $13.18 | $18.20 | $21.38 |
Where Pennsylvania sits
The same service costs 3.5 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· 42nd of 51
$204
AK $617KY $178
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.