How much rates vary
Facilitymedian $1,096 · 10th to 90th $490 to $5,012Professionalmedian $407 · 10th to 90th $372 to $575
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 $676.08 Median $4,073.80 Typical High $8,317.64 | Facility | None | $676.08 | $4,073.80 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $371.54 Median $398.11 Typical High $426.58 | Professional | None | $371.54 | $398.11 | $426.58 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $257.04 Median $281.84 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $257.04 | $281.84 | $302.00 |
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 $602.56 Median $645.65 Typical High $56,234.13 | Professional | None | $602.56 | $645.65 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $295.12 Typical High $524.81 | Professional | 78 · Unplanned return to OR | $288.40 | $295.12 | $524.81 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $891.25 Typical High $1,698.24 | Facility | None | $501.19 | $891.25 | $1,698.24 |
Cigna Setting Professional Modifier None Typical Low $371.54 Median $407.38 Typical High $891.25 | Professional | None | $371.54 | $407.38 | $891.25 |
Emblem Health Setting Professional Modifier None Typical Low $501.19 Median $676.08 Typical High $676.08 | Professional | None | $501.19 | $676.08 | $676.08 |
Geisinger Setting Facility Modifier None Typical Low $851.14 Median $1,047.13 Typical High $1,862.09 | Facility | None | $851.14 | $1,047.13 | $1,862.09 |
Geisinger Setting Professional Modifier None Typical Low $371.54 Median $501.19 Typical High $831.76 | Professional | None | $371.54 | $501.19 | $831.76 |
Highmark BCBS Setting Facility Modifier None Typical Low $602.56 Median $1,122.02 Typical High $9,549.93 | Facility | None | $602.56 | $1,122.02 | $9,549.93 |
Highmark BCBS Setting Professional Modifier None Typical Low $389.05 Median $389.05 Typical High $489.78 | Professional | None | $389.05 | $389.05 | $489.78 |
Martin's Point Setting Facility Modifier None Typical Low $776.25 Median $3,801.89 Typical High $8,317.64 | Facility | None | $776.25 | $3,801.89 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $371.54 Median $398.11 Typical High $426.58 | Professional | None | $371.54 | $398.11 | $426.58 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $257.04 Median $281.84 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $257.04 | $281.84 | $302.00 |
Oscar Health Setting Professional Modifier None Typical Low $489.78 Median $537.03 Typical High $794.33 | Professional | None | $489.78 | $537.03 | $794.33 |
UPMC Health Plan Setting Facility Modifier None Typical Low $407.38 Median $1,737.80 Typical High $3,388.44 | Facility | None | $407.38 | $1,737.80 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $407.38 Median $489.78 Typical High $489.78 | Professional | None | $407.38 | $489.78 | $489.78 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,548.13 | Facility | None | $416.87 | $724.44 | $3,548.13 |
United Setting Professional Modifier None Typical Low $371.54 Median $436.52 Typical High $660.69 | Professional | None | $371.54 | $436.52 | $660.69 |
10 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 $186.21 Median $199.53 Typical High $213.80 | Professional | 52 · Reduced service | $186.21 | $199.53 | $213.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $74.13 Median $79.43 Typical High $85.11 | Professional | 53 · Discontinued | $74.13 | $79.43 | $85.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $275.42 Median $302.00 Typical High $323.59 | Professional | 54 · Surgery only | $275.42 | $302.00 | $323.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $54.95 Median $60.26 Typical High $64.57 | Professional | 55 · Aftercare only | $54.95 | $60.26 | $64.57 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $37.15 Median $39.81 Typical High $42.66 | Professional | 56 · Pre-op care only | $37.15 | $39.81 | $42.66 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $186.21 Median $199.53 Typical High $213.80 | Professional | 52 · Reduced service | $186.21 | $199.53 | $213.80 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $74.13 Median $79.43 Typical High $85.11 | Professional | 53 · Discontinued | $74.13 | $79.43 | $85.11 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $275.42 Median $302.00 Typical High $323.59 | Professional | 54 · Surgery only | $275.42 | $302.00 | $323.59 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $54.95 Median $60.26 Typical High $64.57 | Professional | 55 · Aftercare only | $54.95 | $60.26 | $64.57 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $37.15 Median $39.81 Typical High $42.66 | Professional | 56 · Pre-op care only | $37.15 | $39.81 | $42.66 |
Where Pennsylvania sits
The same service costs 4.0 times more in Colorado than in Maryland. 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
CO $4,941MD $1,230
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.