How much rates vary
Facilitymedian $1,995 · 10th to 90th $724 to $5,888Professionalmedian $794 · 10th to 90th $724 to $1,096
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 $831.76 Median $4,073.80 Typical High $8,317.64 | Facility | None | $831.76 | $4,073.80 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $724.44 Median $776.25 Typical High $851.14 | Professional | None | $724.44 | $776.25 | $851.14 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $537.03 Typical High $602.56 | Professional | 78 · Unplanned return to OR | $512.86 | $537.03 | $602.56 |
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 $1,174.90 Median $1,258.93 Typical High $56,234.13 | Professional | None | $1,174.90 | $1,258.93 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $562.34 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $537.03 | $562.34 | $977.24 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,584.89 Typical High $2,691.53 | Facility | None | $501.19 | $1,584.89 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $741.31 Median $758.58 Typical High $1,698.24 | Professional | None | $741.31 | $758.58 | $1,698.24 |
Emblem Health Setting Professional Modifier None Typical Low $1,023.29 Median $1,348.96 Typical High $1,348.96 | Professional | None | $1,023.29 | $1,348.96 | $1,348.96 |
Geisinger Setting Facility Modifier None Typical Low $1,584.89 Median $1,995.26 Typical High $3,467.37 | Facility | None | $1,584.89 | $1,995.26 | $3,467.37 |
Geisinger Setting Professional Modifier None Typical Low $741.31 Median $1,000.00 Typical High $1,698.24 | Professional | None | $741.31 | $1,000.00 | $1,698.24 |
Martin's Point Setting Facility Modifier None Typical Low $851.14 Median $3,801.89 Typical High $8,317.64 | Facility | None | $851.14 | $3,801.89 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $724.44 Median $758.58 Typical High $851.14 | Professional | None | $724.44 | $758.58 | $851.14 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $537.03 Typical High $602.56 | Professional | 78 · Unplanned return to OR | $512.86 | $537.03 | $602.56 |
Oscar Health Setting Professional Modifier None Typical Low $954.99 Median $954.99 Typical High $1,479.11 | Professional | None | $954.99 | $954.99 | $1,479.11 |
UPMC Health Plan Setting Facility Modifier None Typical Low $776.25 Median $1,737.80 Typical High $3,388.44 | Facility | None | $776.25 | $1,737.80 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $776.25 Median $851.14 Typical High $851.14 | Professional | None | $776.25 | $851.14 | $851.14 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,905.46 Typical High $5,888.44 | Facility | None | $1,148.15 | $1,905.46 | $5,888.44 |
United Setting Professional Modifier None Typical Low $691.83 Median $831.76 Typical High $1,258.93 | Professional | None | $691.83 | $831.76 | $1,258.93 |
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 $363.08 Median $380.19 Typical High $426.58 | Professional | 52 · Reduced service | $363.08 | $380.19 | $426.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $154.88 Typical High $169.82 | Professional | 53 · Discontinued | $144.54 | $154.88 | $169.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $575.44 Typical High $645.65 | Professional | 54 · Surgery only | $549.54 | $575.44 | $645.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $114.82 Typical High $128.82 | Professional | 55 · Aftercare only | $109.65 | $114.82 | $128.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $75.86 Typical High $85.11 | Professional | 56 · Pre-op care only | $72.44 | $75.86 | $85.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $363.08 Median $380.19 Typical High $426.58 | Professional | 52 · Reduced service | $363.08 | $380.19 | $426.58 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $151.36 Typical High $169.82 | Professional | 53 · Discontinued | $144.54 | $151.36 | $169.82 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $575.44 Typical High $645.65 | Professional | 54 · Surgery only | $549.54 | $575.44 | $645.65 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $114.82 Typical High $128.82 | Professional | 55 · Aftercare only | $109.65 | $114.82 | $128.82 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $75.86 Typical High $85.11 | Professional | 56 · Pre-op care only | $72.44 | $75.86 | $85.11 |
Where Pennsylvania sits
The same service costs 3.1 times more in Wisconsin than in Hawaii. 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
WI $7,619HI $2,493
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.