How much rates vary
Facilitymedian $3,388 · 10th to 90th $851 to $7,586Professionalmedian $912 · 10th to 90th $832 to $1,288
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 $4,897.79 Typical High $8,511.38 | Facility | None | $977.24 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $831.76 Median $912.01 Typical High $977.24 | Professional | None | $831.76 | $912.01 | $977.24 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $630.96 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $588.84 | $630.96 | $691.83 |
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 $1,348.96 Median $1,445.44 Typical High $56,234.13 | Professional | None | $1,348.96 | $1,445.44 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $616.60 Median $645.65 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $616.60 | $645.65 | $1,122.02 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $3,311.31 Typical High $5,888.44 | Facility | None | $616.60 | $3,311.31 | $5,888.44 |
Cigna Setting Professional Modifier None Typical Low $870.96 Median $891.25 Typical High $1,995.26 | Professional | None | $870.96 | $891.25 | $1,995.26 |
Emblem Health Setting Professional Modifier None Typical Low $1,148.15 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,148.15 | $1,548.82 | $1,548.82 |
Geisinger Setting Facility Modifier None Typical Low $3,630.78 Median $4,466.84 Typical High $7,943.28 | Facility | None | $3,630.78 | $4,466.84 | $7,943.28 |
Geisinger Setting Professional Modifier None Typical Low $851.14 Median $1,174.90 Typical High $2,041.74 | Professional | None | $851.14 | $1,174.90 | $2,041.74 |
Highmark BCBS Setting Facility Modifier None Typical Low $33,884.42 Median $33,884.42 Typical High $33,884.42 | Facility | None | $33,884.42 | $33,884.42 | $33,884.42 |
Highmark BCBS Setting Professional Modifier None Typical Low $891.25 Median $891.25 Typical High $891.25 | Professional | None | $891.25 | $891.25 | $891.25 |
Martin's Point Setting Facility Modifier None Typical Low $977.24 Median $4,786.30 Typical High $8,511.38 | Facility | None | $977.24 | $4,786.30 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $831.76 Median $912.01 Typical High $977.24 | Professional | None | $831.76 | $912.01 | $977.24 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $616.60 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $588.84 | $616.60 | $691.83 |
Oscar Health Setting Professional Modifier None Typical Low $1,096.48 Median $1,148.15 Typical High $1,778.28 | Professional | None | $1,096.48 | $1,148.15 | $1,778.28 |
UPMC Health Plan Setting Facility Modifier None Typical Low $891.25 Median $2,137.96 Typical High $4,265.80 | Facility | None | $891.25 | $2,137.96 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $891.25 Median $1,071.52 Typical High $1,071.52 | Professional | None | $891.25 | $1,071.52 | $1,071.52 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,905.46 Typical High $6,025.60 | Facility | None | $1,148.15 | $1,905.46 | $6,025.60 |
United Setting Professional Modifier None Typical Low $812.83 Median $954.99 Typical High $1,479.11 | Professional | None | $812.83 | $954.99 | $1,479.11 |
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 $416.87 Median $457.09 Typical High $489.78 | Professional | 52 · Reduced service | $416.87 | $457.09 | $489.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $165.96 Median $181.97 Typical High $194.98 | Professional | 53 · Discontinued | $165.96 | $181.97 | $194.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $676.08 Typical High $741.31 | Professional | 54 · Surgery only | $630.96 | $676.08 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $134.90 Typical High $147.91 | Professional | 55 · Aftercare only | $125.89 | $134.90 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $91.20 Typical High $97.72 | Professional | 56 · Pre-op care only | $83.18 | $91.20 | $97.72 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $416.87 Median $436.52 Typical High $489.78 | Professional | 52 · Reduced service | $416.87 | $436.52 | $489.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $165.96 Median $173.78 Typical High $194.98 | Professional | 53 · Discontinued | $165.96 | $173.78 | $194.98 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $660.69 Typical High $741.31 | Professional | 54 · Surgery only | $630.96 | $660.69 | $741.31 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $131.83 Typical High $147.91 | Professional | 55 · Aftercare only | $125.89 | $131.83 | $147.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $87.10 Typical High $97.72 | Professional | 56 · Pre-op care only | $83.18 | $87.10 | $97.72 |
Where Pennsylvania sits
The same service costs 4.2 times more in Colorado 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
CO $12,508MT $2,994
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.