How much rates vary
Facilitymedian $257 · 10th to 90th $78 to $3,467Professionalmedian $282 · 10th to 90th $234 to $468
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 $309.03 Median $2,137.96 Typical High $7,943.28 | Facility | None | $309.03 | $2,137.96 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $234.42 Median $269.15 Typical High $323.59 | Professional | None | $234.42 | $269.15 | $323.59 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $190.55 Typical High $213.80 | Professional | 78 · Unplanned return to OR | $165.96 | $190.55 | $213.80 |
Capital Blue Cross Setting Facility Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $56,234.13 | Facility | None | $1,202.26 | $1,412.54 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $302.00 Median $309.03 Typical High $524.81 | Professional | None | $302.00 | $309.03 | $524.81 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $208.93 Median $213.80 Typical High $363.08 | Professional | 78 · Unplanned return to OR | $208.93 | $213.80 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $147.91 Typical High $275.42 | Facility | None | $50.12 | $147.91 | $275.42 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $269.15 Typical High $489.78 | Professional | None | $204.17 | $269.15 | $489.78 |
Emblem Health Setting Professional Modifier None Typical Low $426.58 Median $575.44 Typical High $575.44 | Professional | None | $426.58 | $575.44 | $575.44 |
Geisinger Setting Facility Modifier None Typical Low $131.83 Median $165.96 Typical High $288.40 | Facility | None | $131.83 | $165.96 | $288.40 |
Geisinger Setting Professional Modifier None Typical Low $229.09 Median $363.08 Typical High $562.34 | Professional | None | $229.09 | $363.08 | $562.34 |
Highmark BCBS Setting Facility Modifier None Typical Low $257.04 Median $1,148.15 Typical High $1,513.56 | Facility | None | $257.04 | $1,148.15 | $1,513.56 |
Highmark BCBS Setting Professional Modifier None Typical Low $309.03 Median $323.59 Typical High $380.19 | Professional | None | $309.03 | $323.59 | $380.19 |
Martin's Point Setting Facility Modifier None Typical Low $309.03 Median $1,995.26 Typical High $6,760.83 | Facility | None | $309.03 | $1,995.26 | $6,760.83 |
Martin's Point Setting Professional Modifier None Typical Low $234.42 Median $269.15 Typical High $309.03 | Professional | None | $234.42 | $269.15 | $309.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $190.55 Typical High $213.80 | Professional | 78 · Unplanned return to OR | $165.96 | $190.55 | $213.80 |
Oscar Health Setting Professional Modifier None Typical Low $288.40 Median $288.40 Typical High $501.19 | Professional | None | $288.40 | $288.40 | $501.19 |
UPMC Health Plan Setting Facility Modifier None Typical Low $199.53 Median $338.84 Typical High $776.25 | Facility | None | $199.53 | $338.84 | $776.25 |
UPMC Health Plan Setting Professional Modifier None Typical Low $199.53 Median $245.47 Typical High $288.40 | Professional | None | $199.53 | $245.47 | $288.40 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,230.27 | Facility | None | $77.62 | $158.49 | $1,230.27 |
United Setting Professional Modifier None Typical Low $218.78 Median $295.12 Typical High $446.68 | Professional | None | $218.78 | $295.12 | $446.68 |
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 $117.49 Median $134.90 Typical High $154.88 | Professional | 52 · Reduced service | $117.49 | $134.90 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $53.70 Typical High $61.66 | Professional | 53 · Discontinued | $46.77 | $53.70 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $177.83 Median $204.17 Typical High $229.09 | Professional | 54 · Surgery only | $177.83 | $204.17 | $229.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $40.74 Typical High $45.71 | Professional | 55 · Aftercare only | $35.48 | $40.74 | $45.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $26.92 Typical High $30.90 | Professional | 56 · Pre-op care only | $23.44 | $26.92 | $30.90 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $446.68 Median $467.74 Typical High $794.33 | Professional | 50 · Both sides | $446.68 | $467.74 | $794.33 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $117.49 Median $134.90 Typical High $154.88 | Professional | 52 · Reduced service | $117.49 | $134.90 | $154.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $53.70 Typical High $61.66 | Professional | 53 · Discontinued | $46.77 | $53.70 | $61.66 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $177.83 Median $204.17 Typical High $229.09 | Professional | 54 · Surgery only | $177.83 | $204.17 | $229.09 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $40.74 Typical High $45.71 | Professional | 55 · Aftercare only | $35.48 | $40.74 | $45.71 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $26.92 Typical High $30.90 | Professional | 56 · Pre-op care only | $23.44 | $26.92 | $30.90 |
Where Pennsylvania sits
The same service costs 5.4 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· 41st of 51
$282
AK $1,096TX $204
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.