How much rates vary
Facilitymedian $209 · 10th to 90th $78 to $4,169Professionalmedian $214 · 10th to 90th $115 to $324
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 $295.12 Median $2,344.23 Typical High $8,317.64 | Facility | None | $295.12 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $114.82 Median $229.09 Typical High $295.12 | Professional | None | $114.82 | $229.09 | $295.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $81.28 Median $114.82 Typical High $208.93 | Professional | 78 · Unplanned return to OR | $81.28 | $114.82 | $208.93 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,454.71 Median $2,570.40 Typical High $8,709.64 | Facility | None | $2,454.71 | $2,570.40 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $263.03 Median $263.03 Typical High $263.03 | Professional | None | $263.03 | $263.03 | $263.03 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $204.17 Median $302.00 Typical High $380.19 | Professional | 78 · Unplanned return to OR | $204.17 | $302.00 | $380.19 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $141.25 Typical High $263.03 | Facility | None | $50.12 | $141.25 | $263.03 |
Cigna Setting Professional Modifier None Typical Low $107.15 Median $213.80 Typical High $407.38 | Professional | None | $107.15 | $213.80 | $407.38 |
Emblem Health Setting Professional Modifier None Typical Low $436.52 Median $436.52 Typical High $446.68 | Professional | None | $436.52 | $436.52 | $446.68 |
Geisinger Setting Facility Modifier None Typical Low $125.89 Median $158.49 Typical High $275.42 | Facility | None | $125.89 | $158.49 | $275.42 |
Geisinger Setting Professional Modifier None Typical Low $117.49 Median $257.04 Typical High $426.58 | Professional | None | $117.49 | $257.04 | $426.58 |
Martin's Point Setting Facility Modifier None Typical Low $478.63 Median $2,137.96 Typical High $7,244.36 | Facility | None | $478.63 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $114.82 Median $234.42 Typical High $295.12 | Professional | None | $114.82 | $234.42 | $295.12 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $81.28 Median $114.82 Typical High $208.93 | Professional | 78 · Unplanned return to OR | $81.28 | $114.82 | $208.93 |
Oscar Health Setting Professional Modifier None Typical Low $158.49 Median $165.96 Typical High $478.63 | Professional | None | $158.49 | $165.96 | $478.63 |
UPMC Health Plan Setting Facility Modifier None Typical Low $109.65 Median $2,398.83 Typical High $5,623.41 | Facility | None | $109.65 | $2,398.83 | $5,623.41 |
UPMC Health Plan Setting Professional Modifier None Typical Low $109.65 Median $144.54 Typical High $257.04 | Professional | None | $109.65 | $144.54 | $257.04 |
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 $107.15 Median $208.93 Typical High $398.11 | Professional | None | $107.15 | $208.93 | $398.11 |
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 $57.54 Median $83.18 Typical High $147.91 | Professional | 52 · Reduced service | $57.54 | $83.18 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $33.11 Typical High $58.88 | Professional | 53 · Discontinued | $22.91 | $33.11 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $123.03 Typical High $223.87 | Professional | 54 · Surgery only | $87.10 | $123.03 | $223.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $25.12 Typical High $44.67 | Professional | 55 · Aftercare only | $17.38 | $25.12 | $44.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $16.60 Typical High $29.51 | Professional | 56 · Pre-op care only | $11.48 | $16.60 | $29.51 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $57.54 Median $83.18 Typical High $147.91 | Professional | 52 · Reduced service | $57.54 | $83.18 | $147.91 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $33.11 Typical High $58.88 | Professional | 53 · Discontinued | $22.91 | $33.11 | $58.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $123.03 Typical High $223.87 | Professional | 54 · Surgery only | $87.10 | $123.03 | $223.87 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $25.12 Typical High $44.67 | Professional | 55 · Aftercare only | $17.38 | $25.12 | $44.67 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $16.60 Typical High $29.51 | Professional | 56 · Pre-op care only | $11.48 | $16.60 | $29.51 |
Where Pennsylvania sits
The same service costs 3.6 times more in Wisconsin than in Kentucky. 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· 39th of 51
$214
WI $490KY $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.