How much rates vary
Facilitymedian $2,089 · 10th to 90th $776 to $7,244Professionalmedian $617 · 10th to 90th $525 to $1,096
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 $616.60 Median $4,897.79 Typical High $8,511.38 | Facility | None | $616.60 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $524.81 Median $575.44 Typical High $660.69 | Professional | None | $524.81 | $575.44 | $660.69 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $371.54 Median $407.38 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $371.54 | $407.38 | $426.58 |
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 $588.84 Median $616.60 Typical High $1,148.15 | Professional | None | $588.84 | $616.60 | $1,148.15 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $407.38 Median $426.58 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $407.38 | $426.58 | $794.33 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,659.59 Typical High $3,162.28 | Facility | None | $707.95 | $1,659.59 | $3,162.28 |
Cigna Setting Professional Modifier None Typical Low $537.03 Median $602.56 Typical High $1,288.25 | Professional | None | $537.03 | $602.56 | $1,288.25 |
Emblem Health Setting Professional Modifier None Typical Low $724.44 Median $977.24 Typical High $977.24 | Professional | None | $724.44 | $977.24 | $977.24 |
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 $537.03 Median $707.95 Typical High $1,202.26 | Professional | None | $537.03 | $707.95 | $1,202.26 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,348.96 Median $3,890.45 Typical High $14,125.38 | Facility | None | $1,348.96 | $3,890.45 | $14,125.38 |
Highmark BCBS Setting Professional Modifier None Typical Low $562.34 Median $630.96 Typical High $707.95 | Professional | None | $562.34 | $630.96 | $707.95 |
Martin's Point Setting Facility Modifier None Typical Low $616.60 Median $4,897.79 Typical High $8,709.64 | Facility | None | $616.60 | $4,897.79 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $524.81 Median $575.44 Typical High $645.65 | Professional | None | $524.81 | $575.44 | $645.65 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $371.54 Median $398.11 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $371.54 | $398.11 | $426.58 |
Oscar Health Setting Professional Modifier None Typical Low $691.83 Median $707.95 Typical High $1,148.15 | Professional | None | $691.83 | $707.95 | $1,148.15 |
UPMC Health Plan Setting Facility Modifier None Typical Low $575.44 Median $2,570.40 Typical High $5,011.87 | Facility | None | $575.44 | $2,570.40 | $5,011.87 |
UPMC Health Plan Setting Professional Modifier None Typical Low $575.44 Median $630.96 Typical High $630.96 | Professional | None | $575.44 | $630.96 | $630.96 |
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 $630.96 Typical High $954.99 | Professional | None | $537.03 | $630.96 | $954.99 |
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 $263.03 Median $288.40 Typical High $309.03 | Professional | 52 · Reduced service | $263.03 | $288.40 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $104.71 Median $114.82 Typical High $123.03 | Professional | 53 · Discontinued | $104.71 | $114.82 | $123.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $398.11 Median $436.52 Typical High $457.09 | Professional | 54 · Surgery only | $398.11 | $436.52 | $457.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $79.43 Median $87.10 Typical High $91.20 | Professional | 55 · Aftercare only | $79.43 | $87.10 | $91.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $52.48 Median $57.54 Typical High $61.66 | Professional | 56 · Pre-op care only | $52.48 | $57.54 | $61.66 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $891.25 Median $933.25 Typical High $1,698.24 | Professional | 50 · Both sides | $891.25 | $933.25 | $1,698.24 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $263.03 Median $288.40 Typical High $309.03 | Professional | 52 · Reduced service | $263.03 | $288.40 | $309.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $104.71 Median $114.82 Typical High $123.03 | Professional | 53 · Discontinued | $104.71 | $114.82 | $123.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $398.11 Median $426.58 Typical High $457.09 | Professional | 54 · Surgery only | $398.11 | $426.58 | $457.09 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $79.43 Median $85.11 Typical High $91.20 | Professional | 55 · Aftercare only | $79.43 | $85.11 | $91.20 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $52.48 Median $57.54 Typical High $61.66 | Professional | 56 · Pre-op care only | $52.48 | $57.54 | $61.66 |
Where Pennsylvania sits
The same service costs 3.9 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 $7,471MT $1,932
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.