How much rates vary
Facilitymedian $2,042 · 10th to 90th $724 to $6,457Professionalmedian $589 · 10th to 90th $513 to $1,023
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 $4,897.79 Typical High $8,511.38 | Facility | None | $812.83 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $512.86 Median $562.34 Typical High $588.84 | Professional | None | $512.86 | $562.34 | $588.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $354.81 Median $389.05 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $354.81 | $389.05 | $416.87 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $56,234.13 | Facility | None | $3,981.07 | $7,413.10 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $562.34 Median $588.84 Typical High $1,071.52 | Professional | None | $562.34 | $588.84 | $1,071.52 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $389.05 Median $407.38 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $389.05 | $407.38 | $741.31 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,584.89 Typical High $2,818.38 | Facility | None | $616.60 | $1,584.89 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $537.03 Median $575.44 Typical High $1,230.27 | Professional | None | $537.03 | $575.44 | $1,230.27 |
Emblem Health Setting Professional Modifier None Typical Low $691.83 Median $933.25 Typical High $933.25 | Professional | None | $691.83 | $933.25 | $933.25 |
Geisinger Setting Facility Modifier None Typical Low $1,584.89 Median $1,995.26 Typical High $3,467.37 | Facility | None | $1,584.89 | $1,995.26 | $3,467.37 |
Geisinger Setting Professional Modifier None Typical Low $524.81 Median $707.95 Typical High $1,202.26 | Professional | None | $524.81 | $707.95 | $1,202.26 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $4,570.88 Typical High $8,511.38 | Facility | None | $831.76 | $4,570.88 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $512.86 Median $562.34 Typical High $588.84 | Professional | None | $512.86 | $562.34 | $588.84 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $354.81 Median $389.05 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $354.81 | $389.05 | $416.87 |
Oscar Health Setting Professional Modifier None Typical Low $660.69 Median $776.25 Typical High $1,122.02 | Professional | None | $660.69 | $776.25 | $1,122.02 |
UPMC Health Plan Setting Facility Modifier None Typical Low $562.34 Median $2,137.96 Typical High $4,168.69 | Facility | None | $562.34 | $2,137.96 | $4,168.69 |
UPMC Health Plan Setting Professional Modifier None Typical Low $562.34 Median $660.69 Typical High $660.69 | Professional | None | $562.34 | $660.69 | $660.69 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,905.46 Typical High $5,888.44 | Facility | None | $1,148.15 | $1,905.46 | $5,888.44 |
United Setting Professional Modifier None Typical Low $537.03 Median $616.60 Typical High $933.25 | Professional | None | $537.03 | $616.60 | $933.25 |
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 $257.04 Median $275.42 Typical High $295.12 | Professional | 52 · Reduced service | $257.04 | $275.42 | $295.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $102.33 Median $112.20 Typical High $117.49 | Professional | 53 · Discontinued | $102.33 | $112.20 | $117.49 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $380.19 Median $416.87 Typical High $446.68 | Professional | 54 · Surgery only | $380.19 | $416.87 | $446.68 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $77.62 Median $83.18 Typical High $89.13 | Professional | 55 · Aftercare only | $77.62 | $83.18 | $89.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $51.29 Median $56.23 Typical High $58.88 | Professional | 56 · Pre-op care only | $51.29 | $56.23 | $58.88 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $851.14 Median $870.96 Typical High $1,621.81 | Professional | 50 · Both sides | $851.14 | $870.96 | $1,621.81 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $257.04 Median $275.42 Typical High $295.12 | Professional | 52 · Reduced service | $257.04 | $275.42 | $295.12 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $102.33 Median $109.65 Typical High $117.49 | Professional | 53 · Discontinued | $102.33 | $109.65 | $117.49 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $380.19 Median $416.87 Typical High $446.68 | Professional | 54 · Surgery only | $380.19 | $416.87 | $446.68 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $77.62 Median $83.18 Typical High $89.13 | Professional | 55 · Aftercare only | $77.62 | $83.18 | $89.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $51.29 Median $54.95 Typical High $58.88 | Professional | 56 · Pre-op care only | $51.29 | $54.95 | $58.88 |
Where Pennsylvania sits
The same service costs 4.1 times more in Wisconsin than in Montana. 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 $7,505MT $1,845
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.