How much rates vary
Facilitymedian $1,698 · 10th to 90th $537 to $6,761Professionalmedian $1,023 · 10th to 90th $891 to $1,514
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 $1,023.29 Median $5,495.41 Typical High $8,709.64 | Facility | None | $1,023.29 | $5,495.41 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $933.25 Median $1,023.29 Typical High $1,096.48 | Professional | None | $933.25 | $1,023.29 | $1,096.48 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $676.08 Typical High $758.58 | Professional | 78 · Unplanned return to OR | $660.69 | $676.08 | $758.58 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $56,234.13 | Facility | None | $3,981.07 | $4,365.16 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,659.59 Median $1,659.59 Typical High $1,659.59 | Professional | None | $1,659.59 | $1,659.59 | $1,659.59 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $758.58 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $724.44 | $758.58 | $1,288.25 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,659.59 Typical High $3,162.28 | Facility | None | $707.95 | $1,659.59 | $3,162.28 |
Cigna Setting Professional Modifier None Typical Low $891.25 Median $1,000.00 Typical High $2,290.87 | Professional | None | $891.25 | $1,000.00 | $2,290.87 |
Emblem Health Setting Professional Modifier None Typical Low $1,230.27 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,230.27 | $1,698.24 | $1,698.24 |
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 $912.01 Median $1,202.26 Typical High $2,089.30 | Professional | None | $912.01 | $1,202.26 | $2,089.30 |
Highmark BCBS Setting Facility Modifier None Typical Low $0.50 Median $4,466.84 Typical High $14,454.40 | Facility | None | $0.50 | $4,466.84 | $14,454.40 |
Highmark BCBS Setting Professional Modifier None Typical Low $1,445.44 Median $1,862.09 Typical High $4,786.30 | Professional | None | $1,445.44 | $1,862.09 | $4,786.30 |
Martin's Point Setting Facility Modifier None Typical Low $1,096.48 Median $4,897.79 Typical High $8,709.64 | Facility | None | $1,096.48 | $4,897.79 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $933.25 Median $977.24 Typical High $1,096.48 | Professional | None | $933.25 | $977.24 | $1,096.48 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $676.08 Typical High $758.58 | Professional | 78 · Unplanned return to OR | $660.69 | $676.08 | $758.58 |
Oscar Health Setting Professional Modifier None Typical Low $812.83 Median $812.83 Typical High $1,862.09 | Professional | None | $812.83 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,000.00 Median $2,570.40 Typical High $5,011.87 | Facility | None | $1,000.00 | $2,570.40 | $5,011.87 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,000.00 Median $1,000.00 Typical High $1,023.29 | Professional | None | $1,000.00 | $1,000.00 | $1,023.29 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $4,265.80 | Facility | None | $416.87 | $724.44 | $4,265.80 |
United Setting Professional Modifier None Typical Low $891.25 Median $1,122.02 Typical High $1,698.24 | Professional | None | $891.25 | $1,122.02 | $1,698.24 |
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 $467.74 Median $489.78 Typical High $549.54 | Professional | 52 · Reduced service | $467.74 | $489.78 | $549.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $186.21 Median $194.98 Typical High $218.78 | Professional | 53 · Discontinued | $186.21 | $194.98 | $218.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $707.95 Median $724.44 Typical High $812.83 | Professional | 54 · Surgery only | $707.95 | $724.44 | $812.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $141.25 Median $144.54 Typical High $162.18 | Professional | 55 · Aftercare only | $141.25 | $144.54 | $162.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $93.33 Median $97.72 Typical High $109.65 | Professional | 56 · Pre-op care only | $93.33 | $97.72 | $109.65 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $467.74 Median $489.78 Typical High $549.54 | Professional | 52 · Reduced service | $467.74 | $489.78 | $549.54 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $186.21 Median $194.98 Typical High $218.78 | Professional | 53 · Discontinued | $186.21 | $194.98 | $218.78 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $707.95 Median $724.44 Typical High $812.83 | Professional | 54 · Surgery only | $707.95 | $724.44 | $812.83 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $141.25 Median $144.54 Typical High $162.18 | Professional | 55 · Aftercare only | $141.25 | $144.54 | $162.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $93.33 Median $97.72 Typical High $109.65 | Professional | 56 · Pre-op care only | $93.33 | $97.72 | $109.65 |
Where Pennsylvania sits
The same service costs 7.6 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
$1,023
AK $4,266TX $562
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.