How much rates vary
Facilitymedian $562 · 10th to 90th $200 to $3,981Professionalmedian $245 · 10th to 90th $151 to $407
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 $275.42 Median $2,344.23 Typical High $8,317.64 | Facility | None | $275.42 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $147.91 Median $234.42 Typical High $275.42 | Professional | None | $147.91 | $234.42 | $275.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $102.33 Median $154.88 Typical High $194.98 | Professional | 78 · Unplanned return to OR | $102.33 | $154.88 | $194.98 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $8,709.64 | Facility | None | $3,981.07 | $4,365.16 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $251.19 Median $263.03 Typical High $478.63 | Professional | None | $251.19 | $263.03 | $478.63 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $199.53 Median $208.93 Typical High $380.19 | Professional | 78 · Unplanned return to OR | $199.53 | $208.93 | $380.19 |
Cigna Setting Facility Modifier None Typical Low $199.53 Median $323.59 Typical High $562.34 | Facility | None | $199.53 | $323.59 | $562.34 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $223.87 Typical High $371.54 | Professional | None | $147.91 | $223.87 | $371.54 |
Emblem Health Setting Professional Modifier None Typical Low $338.84 Median $446.68 Typical High $446.68 | Professional | None | $338.84 | $446.68 | $446.68 |
Geisinger Setting Facility Modifier None Typical Low $177.83 Median $223.87 Typical High $389.05 | Facility | None | $177.83 | $223.87 | $389.05 |
Geisinger Setting Professional Modifier None Typical Low $194.98 Median $295.12 Typical High $489.78 | Professional | None | $194.98 | $295.12 | $489.78 |
Highmark BCBS Setting Facility Modifier None Typical Low $346.74 Median $346.74 Typical High $346.74 | Facility | None | $346.74 | $346.74 | $346.74 |
Martin's Point Setting Facility Modifier None Typical Low $478.63 Median $2,137.96 Typical High $7,244.36 | Facility | None | $478.63 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $147.91 Median $223.87 Typical High $275.42 | Professional | None | $147.91 | $223.87 | $275.42 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $102.33 Median $154.88 Typical High $194.98 | Professional | 78 · Unplanned return to OR | $102.33 | $154.88 | $194.98 |
Oscar Health Setting Professional Modifier None Typical Low $295.12 Median $295.12 Typical High $489.78 | Professional | None | $295.12 | $295.12 | $489.78 |
UPMC Health Plan Setting Facility Modifier None Typical Low $194.98 Median $812.83 Typical High $1,862.09 | Facility | None | $194.98 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $158.49 Median $251.19 Typical High $269.15 | Professional | None | $158.49 | $251.19 | $269.15 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,630.78 | Facility | None | $416.87 | $724.44 | $3,630.78 |
United Setting Professional Modifier None Typical Low $158.49 Median $229.09 Typical High $338.84 | Professional | None | $158.49 | $229.09 | $338.84 |
12 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 $74.13 Median $112.20 Typical High $138.04 | Professional | 52 · Reduced service | $74.13 | $112.20 | $138.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $29.51 Median $44.67 Typical High $54.95 | Professional | 53 · Discontinued | $29.51 | $44.67 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $165.96 Typical High $208.93 | Professional | 54 · Surgery only | $109.65 | $165.96 | $208.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $33.11 Typical High $41.69 | Professional | 55 · Aftercare only | $21.88 | $33.11 | $41.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.79 Median $22.39 Typical High $27.54 | Professional | 56 · Pre-op care only | $14.79 | $22.39 | $27.54 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $380.19 Median $389.05 Typical High $707.95 | Professional | 50 · Both sides | $380.19 | $389.05 | $707.95 |
Highmark BCBS Setting Professional Modifier GC · Resident with teaching physician Typical Low $177.83 Median $177.83 Typical High $177.83 | Professional | GC · Resident with teaching physician | $177.83 | $177.83 | $177.83 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $74.13 Median $109.65 Typical High $138.04 | Professional | 52 · Reduced service | $74.13 | $109.65 | $138.04 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $29.51 Median $43.65 Typical High $54.95 | Professional | 53 · Discontinued | $29.51 | $43.65 | $54.95 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $165.96 Typical High $208.93 | Professional | 54 · Surgery only | $109.65 | $165.96 | $208.93 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $33.11 Typical High $41.69 | Professional | 55 · Aftercare only | $21.88 | $33.11 | $41.69 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.79 Median $21.88 Typical High $27.54 | Professional | 56 · Pre-op care only | $14.79 | $21.88 | $27.54 |
Where Pennsylvania sits
The same service costs 3.7 times more in Alaska than in Utah. 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· 33rd of 51
$251
AK $692UT $186
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.