How much rates vary
Facilitymedian $204 · 10th to 90th $78 to $3,631Professionalmedian $174 · 10th to 90th $138 to $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 $186.21 Median $2,344.23 Typical High $8,317.64 | Facility | None | $186.21 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $158.49 Typical High $186.21 | Professional | None | $131.83 | $158.49 | $186.21 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $93.33 Median $112.20 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $93.33 | $112.20 | $131.83 |
Capital Blue Cross Setting Facility Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $56,234.13 | Facility | None | $1,202.26 | $1,412.54 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $181.97 Median $190.55 Typical High $331.13 | Professional | None | $181.97 | $190.55 | $331.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $125.89 Median $131.83 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $125.89 | $131.83 | $229.09 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $147.91 Typical High $275.42 | Facility | None | $50.12 | $147.91 | $275.42 |
Cigna Setting Professional Modifier None Typical Low $141.25 Median $162.18 Typical High $302.00 | Professional | None | $141.25 | $162.18 | $302.00 |
Emblem Health Setting Professional Modifier None Typical Low $251.19 Median $331.13 Typical High $331.13 | Professional | None | $251.19 | $331.13 | $331.13 |
Geisinger Setting Facility Modifier None Typical Low $131.83 Median $162.18 Typical High $288.40 | Facility | None | $131.83 | $162.18 | $288.40 |
Geisinger Setting Professional Modifier None Typical Low $112.20 Median $190.55 Typical High $331.13 | Professional | None | $112.20 | $190.55 | $331.13 |
Highmark BCBS Setting Facility Modifier None Typical Low $120.23 Median $645.65 Typical High $2,818.38 | Facility | None | $120.23 | $645.65 | $2,818.38 |
Highmark BCBS Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $218.78 | Professional | None | $218.78 | $218.78 | $218.78 |
Martin's Point Setting Facility Modifier None Typical Low $478.63 Median $2,344.23 Typical High $8,128.31 | Facility | None | $478.63 | $2,344.23 | $8,128.31 |
Martin's Point Setting Professional Modifier None Typical Low $131.83 Median $158.49 Typical High $186.21 | Professional | None | $131.83 | $158.49 | $186.21 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $93.33 Median $112.20 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $93.33 | $112.20 | $131.83 |
Oscar Health Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $331.13 | Professional | None | $177.83 | $177.83 | $331.13 |
UPMC Health Plan Setting Facility Modifier None Typical Low $144.54 Median $1,071.52 Typical High $2,511.89 | Facility | None | $144.54 | $1,071.52 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $144.54 Median $162.18 Typical High $173.78 | Professional | None | $144.54 | $162.18 | $173.78 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,230.27 | Facility | None | $77.62 | $158.49 | $1,230.27 |
United Setting Professional Modifier None Typical Low $141.25 Median $177.83 Typical High $263.03 | Professional | None | $141.25 | $177.83 | $263.03 |
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 $66.07 Median $79.43 Typical High $93.33 | Professional | 52 · Reduced service | $66.07 | $79.43 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $32.36 Typical High $37.15 | Professional | 53 · Discontinued | $26.92 | $32.36 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $120.23 Typical High $141.25 | Professional | 54 · Surgery only | $100.00 | $120.23 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $23.99 Typical High $28.18 | Professional | 55 · Aftercare only | $19.95 | $23.99 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $15.85 Typical High $18.62 | Professional | 56 · Pre-op care only | $13.18 | $15.85 | $18.62 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $275.42 Median $288.40 Typical High $501.19 | Professional | 50 · Both sides | $275.42 | $288.40 | $501.19 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $66.07 Median $79.43 Typical High $93.33 | Professional | 52 · Reduced service | $66.07 | $79.43 | $93.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $32.36 Typical High $37.15 | Professional | 53 · Discontinued | $26.92 | $32.36 | $37.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $120.23 Typical High $141.25 | Professional | 54 · Surgery only | $100.00 | $120.23 | $141.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $23.99 Typical High $28.18 | Professional | 55 · Aftercare only | $19.95 | $23.99 | $28.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $15.85 Typical High $18.62 | Professional | 56 · Pre-op care only | $13.18 | $15.85 | $18.62 |
Where Pennsylvania sits
The same service costs 4.6 times more in Alaska than in Florida. 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· 40th of 51
$174
AK $617FL $135
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.