How much rates vary
Facilitymedian $2,239 · 10th to 90th $1,023 to $7,413Professionalmedian $479 · 10th to 90th $417 to $813
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 $5,754.40 Typical High $10,471.29 | Facility | None | $831.76 | $5,754.40 | $10,471.29 |
Aetna Setting Professional Modifier None Typical Low $416.87 Median $446.68 Typical High $478.63 | Professional | None | $416.87 | $446.68 | $478.63 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $316.23 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $288.40 | $316.23 | $338.84 |
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 $467.74 Median $478.63 Typical High $870.96 | Professional | None | $467.74 | $478.63 | $870.96 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $323.59 Median $331.13 Typical High $588.84 | Professional | 78 · Unplanned return to OR | $323.59 | $331.13 | $588.84 |
Cigna Setting Facility Modifier None Typical Low $954.99 Median $1,659.59 Typical High $3,235.94 | Facility | None | $954.99 | $1,659.59 | $3,235.94 |
Cigna Setting Professional Modifier None Typical Low $426.58 Median $467.74 Typical High $1,000.00 | Professional | None | $426.58 | $467.74 | $1,000.00 |
Emblem Health Setting Professional Modifier None Typical Low $562.34 Median $776.25 Typical High $776.25 | Professional | None | $562.34 | $776.25 | $776.25 |
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 $426.58 Median $575.44 Typical High $954.99 | Professional | None | $426.58 | $575.44 | $954.99 |
Martin's Point Setting Facility Modifier None Typical Low $1,023.29 Median $5,370.32 Typical High $10,964.78 | Facility | None | $1,023.29 | $5,370.32 | $10,964.78 |
Martin's Point Setting Professional Modifier None Typical Low $416.87 Median $446.68 Typical High $478.63 | Professional | None | $416.87 | $446.68 | $478.63 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $316.23 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $288.40 | $316.23 | $338.84 |
Oscar Health Setting Professional Modifier None Typical Low $537.03 Median $630.96 Typical High $891.25 | Professional | None | $537.03 | $630.96 | $891.25 |
UPMC Health Plan Setting Facility Modifier None Typical Low $446.68 Median $3,388.44 Typical High $6,606.93 | Facility | None | $446.68 | $3,388.44 | $6,606.93 |
UPMC Health Plan Setting Professional Modifier None Typical Low $446.68 Median $549.54 Typical High $549.54 | Professional | None | $446.68 | $549.54 | $549.54 |
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 $416.87 Median $501.19 Typical High $741.31 | Professional | None | $416.87 | $501.19 | $741.31 |
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 $204.17 Median $223.87 Typical High $239.88 | Professional | 52 · Reduced service | $204.17 | $223.87 | $239.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $89.13 Typical High $95.50 | Professional | 53 · Discontinued | $83.18 | $89.13 | $95.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $338.84 Typical High $363.08 | Professional | 54 · Surgery only | $309.03 | $338.84 | $363.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $67.61 Typical High $72.44 | Professional | 55 · Aftercare only | $61.66 | $67.61 | $72.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $44.67 Typical High $47.86 | Professional | 56 · Pre-op care only | $41.69 | $44.67 | $47.86 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $691.83 Median $724.44 Typical High $1,288.25 | Professional | 50 · Both sides | $691.83 | $724.44 | $1,288.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $204.17 Median $223.87 Typical High $239.88 | Professional | 52 · Reduced service | $204.17 | $223.87 | $239.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $89.13 Typical High $95.50 | Professional | 53 · Discontinued | $83.18 | $89.13 | $95.50 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $338.84 Typical High $363.08 | Professional | 54 · Surgery only | $309.03 | $338.84 | $363.08 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $67.61 Typical High $72.44 | Professional | 55 · Aftercare only | $61.66 | $67.61 | $72.44 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $44.67 Typical High $47.86 | Professional | 56 · Pre-op care only | $41.69 | $44.67 | $47.86 |
Where Pennsylvania sits
The same service costs 5.1 times more in Washington, DC 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
DC $7,757MT $1,518
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.