How much rates vary
Facilitymedian $4,365 · 10th to 90th $933 to $8,710Professionalmedian $977 · 10th to 90th $851 to $1,698
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 $977.24 Median $5,495.41 Typical High $8,709.64 | Facility | None | $977.24 | $5,495.41 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $851.14 Median $933.25 Typical High $977.24 | Professional | None | $851.14 | $933.25 | $977.24 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $602.56 Median $645.65 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $602.56 | $645.65 | $691.83 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $22,387.21 Typical High $28,183.83 | Facility | None | $3,981.07 | $22,387.21 | $28,183.83 |
Capital Blue Cross Setting Professional Modifier None Typical Low $954.99 Median $977.24 Typical High $1,819.70 | Professional | None | $954.99 | $977.24 | $1,819.70 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $676.08 Typical High $1,258.93 | Professional | 78 · Unplanned return to OR | $660.69 | $676.08 | $1,258.93 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $3,801.89 Typical High $7,585.78 | Facility | None | $707.95 | $3,801.89 | $7,585.78 |
Cigna Setting Professional Modifier None Typical Low $912.01 Median $954.99 Typical High $2,089.30 | Professional | None | $912.01 | $954.99 | $2,089.30 |
Emblem Health Setting Professional Modifier None Typical Low $1,122.02 Median $1,513.56 Typical High $1,513.56 | Professional | None | $1,122.02 | $1,513.56 | $1,513.56 |
Geisinger Setting Facility Modifier None Typical Low $4,570.88 Median $5,623.41 Typical High $10,000.00 | Facility | None | $4,570.88 | $5,623.41 | $10,000.00 |
Geisinger Setting Professional Modifier None Typical Low $891.25 Median $1,148.15 Typical High $2,041.74 | Professional | None | $891.25 | $1,148.15 | $2,041.74 |
Highmark BCBS Setting Facility Modifier None Typical Low $9,549.93 Median $9,549.93 Typical High $9,549.93 | Facility | None | $9,549.93 | $9,549.93 | $9,549.93 |
Highmark BCBS Setting Professional Modifier None Typical Low $1,047.13 Median $1,047.13 Typical High $1,122.02 | Professional | None | $1,047.13 | $1,047.13 | $1,122.02 |
Martin's Point Setting Facility Modifier None Typical Low $977.24 Median $4,897.79 Typical High $8,709.64 | Facility | None | $977.24 | $4,897.79 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $851.14 Median $933.25 Typical High $977.24 | Professional | None | $851.14 | $933.25 | $977.24 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $602.56 Median $645.65 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $602.56 | $645.65 | $691.83 |
Oscar Health Setting Professional Modifier None Typical Low $1,096.48 Median $1,230.27 Typical High $1,905.46 | Professional | None | $1,096.48 | $1,230.27 | $1,905.46 |
UPMC Health Plan Setting Facility Modifier None Typical Low $933.25 Median $2,511.89 Typical High $5,011.87 | Facility | None | $933.25 | $2,511.89 | $5,011.87 |
UPMC Health Plan Setting Professional Modifier None Typical Low $933.25 Median $1,000.00 Typical High $1,000.00 | Professional | None | $933.25 | $1,000.00 | $1,000.00 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,235.94 Typical High $10,000.00 | Facility | None | $1,698.24 | $3,235.94 | $10,000.00 |
United Setting Professional Modifier None Typical Low $891.25 Median $1,047.13 Typical High $1,548.82 | Professional | None | $891.25 | $1,047.13 | $1,548.82 |
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 $426.58 Median $467.74 Typical High $489.78 | Professional | 52 · Reduced service | $426.58 | $467.74 | $489.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $186.21 Typical High $194.98 | Professional | 53 · Discontinued | $169.82 | $186.21 | $194.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $645.65 Median $691.83 Typical High $741.31 | Professional | 54 · Surgery only | $645.65 | $691.83 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $128.82 Median $138.04 Typical High $147.91 | Professional | 55 · Aftercare only | $128.82 | $138.04 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $93.33 Typical High $97.72 | Professional | 56 · Pre-op care only | $85.11 | $93.33 | $97.72 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,412.54 Median $1,479.11 Typical High $2,691.53 | Professional | 50 · Both sides | $1,412.54 | $1,479.11 | $2,691.53 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $426.58 Median $457.09 Typical High $489.78 | Professional | 52 · Reduced service | $426.58 | $457.09 | $489.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $181.97 Typical High $194.98 | Professional | 53 · Discontinued | $169.82 | $181.97 | $194.98 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $645.65 Median $691.83 Typical High $741.31 | Professional | 54 · Surgery only | $645.65 | $691.83 | $741.31 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $128.82 Median $138.04 Typical High $147.91 | Professional | 55 · Aftercare only | $128.82 | $138.04 | $147.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $91.20 Typical High $97.72 | Professional | 56 · Pre-op care only | $85.11 | $91.20 | $97.72 |
Where Pennsylvania sits
The same service costs 7.9 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· 44th of 51
$977
AK $3,890TX $490
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.