How much rates vary
Facilitymedian $3,715 · 10th to 90th $977 to $10,000Professionalmedian $776 · 10th to 90th $676 to $1,413
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 $776.25 Median $4,265.80 Typical High $11,748.98 | Facility | None | $776.25 | $4,265.80 | $11,748.98 |
Aetna Setting Professional Modifier None Typical Low $676.08 Median $724.44 Typical High $776.25 | Professional | None | $676.08 | $724.44 | $776.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $467.74 Median $512.86 Typical High $537.03 | Professional | 78 · Unplanned return to OR | $467.74 | $512.86 | $537.03 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $12,022.64 Typical High $56,234.13 | Facility | None | $3,981.07 | $12,022.64 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $758.58 Median $776.25 Typical High $1,445.44 | Professional | None | $758.58 | $776.25 | $1,445.44 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $537.03 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $512.86 | $537.03 | $1,000.00 |
Cigna Setting Facility Modifier None Typical Low $954.99 Median $3,467.37 Typical High $5,888.44 | Facility | None | $954.99 | $3,467.37 | $5,888.44 |
Cigna Setting Professional Modifier None Typical Low $707.95 Median $758.58 Typical High $1,621.81 | Professional | None | $707.95 | $758.58 | $1,621.81 |
Emblem Health Setting Professional Modifier None Typical Low $891.25 Median $1,202.26 Typical High $1,202.26 | Professional | None | $891.25 | $1,202.26 | $1,202.26 |
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 $707.95 Median $912.01 Typical High $1,584.89 | Professional | None | $707.95 | $912.01 | $1,584.89 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,019.95 Median $7,079.46 Typical High $26,302.68 | Facility | None | $3,019.95 | $7,079.46 | $26,302.68 |
Highmark BCBS Setting Professional Modifier None Typical Low $776.25 Median $851.14 Typical High $954.99 | Professional | None | $776.25 | $851.14 | $954.99 |
Martin's Point Setting Facility Modifier None Typical Low $776.25 Median $4,786.30 Typical High $12,882.50 | Facility | None | $776.25 | $4,786.30 | $12,882.50 |
Martin's Point Setting Professional Modifier None Typical Low $676.08 Median $724.44 Typical High $776.25 | Professional | None | $676.08 | $724.44 | $776.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $467.74 Median $501.19 Typical High $537.03 | Professional | 78 · Unplanned return to OR | $467.74 | $501.19 | $537.03 |
Oscar Health Setting Professional Modifier None Typical Low $870.96 Median $933.25 Typical High $1,479.11 | Professional | None | $870.96 | $933.25 | $1,479.11 |
UPMC Health Plan Setting Facility Modifier None Typical Low $724.44 Median $3,388.44 Typical High $6,606.93 | Facility | None | $724.44 | $3,388.44 | $6,606.93 |
UPMC Health Plan Setting Professional Modifier None Typical Low $724.44 Median $912.01 Typical High $912.01 | Professional | None | $724.44 | $912.01 | $912.01 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,454.71 Typical High $6,918.31 | Facility | None | $1,380.38 | $2,454.71 | $6,918.31 |
United Setting Professional Modifier None Typical Low $707.95 Median $812.83 Typical High $1,202.26 | Professional | None | $707.95 | $812.83 | $1,202.26 |
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 $338.84 Median $363.08 Typical High $389.05 | Professional | 52 · Reduced service | $338.84 | $363.08 | $389.05 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $134.90 Median $144.54 Typical High $154.88 | Professional | 53 · Discontinued | $134.90 | $144.54 | $154.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $501.19 Median $549.54 Typical High $575.44 | Professional | 54 · Surgery only | $501.19 | $549.54 | $575.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $100.00 Median $109.65 Typical High $117.49 | Professional | 55 · Aftercare only | $100.00 | $109.65 | $117.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $67.61 Median $72.44 Typical High $77.62 | Professional | 56 · Pre-op care only | $67.61 | $72.44 | $77.62 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,122.02 Median $1,174.90 Typical High $2,187.76 | Professional | 50 · Both sides | $1,122.02 | $1,174.90 | $2,187.76 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $338.84 Median $363.08 Typical High $389.05 | Professional | 52 · Reduced service | $338.84 | $363.08 | $389.05 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $134.90 Median $144.54 Typical High $154.88 | Professional | 53 · Discontinued | $134.90 | $144.54 | $154.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $501.19 Median $537.03 Typical High $575.44 | Professional | 54 · Surgery only | $501.19 | $537.03 | $575.44 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $100.00 Median $109.65 Typical High $117.49 | Professional | 55 · Aftercare only | $100.00 | $109.65 | $117.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $67.61 Median $72.44 Typical High $77.62 | Professional | 56 · Pre-op care only | $67.61 | $72.44 | $77.62 |
Where Pennsylvania sits
The same service costs 5.9 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 $13,930MT $2,377
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.