How much rates vary
Facilitymedian $1,660 · 10th to 90th $589 to $4,898Professionalmedian $479 · 10th to 90th $398 to $832
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 $645.65 Median $3,090.30 Typical High $8,511.38 | Facility | None | $645.65 | $3,090.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $446.68 Median $489.78 Typical High $575.44 | Professional | None | $446.68 | $489.78 | $575.44 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $316.23 Median $338.84 Typical High $354.81 | Professional | 78 · Unplanned return to OR | $316.23 | $338.84 | $354.81 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $8,709.64 | Facility | None | $3,981.07 | $4,365.16 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $457.09 Median $691.83 Typical High $831.76 | Professional | None | $457.09 | $691.83 | $831.76 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $346.74 Median $524.81 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $346.74 | $524.81 | $630.96 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $1,412.54 Typical High $2,398.83 | Facility | None | $478.63 | $1,412.54 | $2,398.83 |
Cigna Setting Professional Modifier None Typical Low $398.11 Median $446.68 Typical High $812.83 | Professional | None | $398.11 | $446.68 | $812.83 |
Emblem Health Setting Professional Modifier None Typical Low $707.95 Median $707.95 Typical High $741.31 | Professional | None | $707.95 | $707.95 | $741.31 |
Geisinger Setting Facility Modifier None Typical Low $1,445.44 Median $1,778.28 Typical High $3,162.28 | Facility | None | $1,445.44 | $1,778.28 | $3,162.28 |
Geisinger Setting Professional Modifier None Typical Low $389.05 Median $549.54 Typical High $891.25 | Professional | None | $389.05 | $549.54 | $891.25 |
Martin's Point Setting Facility Modifier None Typical Low $724.44 Median $2,754.23 Typical High $8,317.64 | Facility | None | $724.44 | $2,754.23 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $446.68 Median $489.78 Typical High $575.44 | Professional | None | $446.68 | $489.78 | $575.44 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $316.23 Median $338.84 Typical High $354.81 | Professional | 78 · Unplanned return to OR | $316.23 | $338.84 | $354.81 |
Oscar Health Setting Professional Modifier None Typical Low $389.05 Median $426.58 Typical High $851.14 | Professional | None | $389.05 | $426.58 | $851.14 |
UPMC Health Plan Setting Facility Modifier None Typical Low $323.59 Median $1,513.56 Typical High $2,951.21 | Facility | None | $323.59 | $1,513.56 | $2,951.21 |
UPMC Health Plan Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $457.09 | Professional | None | $323.59 | $323.59 | $457.09 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,570.88 | Facility | None | $812.83 | $1,318.26 | $4,570.88 |
United Setting Professional Modifier None Typical Low $363.08 Median $457.09 Typical High $891.25 | Professional | None | $363.08 | $457.09 | $891.25 |
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 $223.87 Median $239.88 Typical High $257.04 | Professional | 52 · Reduced service | $223.87 | $239.88 | $257.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $91.20 Median $97.72 Typical High $102.33 | Professional | 53 · Discontinued | $91.20 | $97.72 | $102.33 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $338.84 Median $363.08 Typical High $380.19 | Professional | 54 · Surgery only | $338.84 | $363.08 | $380.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $72.44 Typical High $75.86 | Professional | 55 · Aftercare only | $67.61 | $72.44 | $75.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $45.71 Median $48.98 Typical High $51.29 | Professional | 56 · Pre-op care only | $45.71 | $48.98 | $51.29 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $691.83 Median $1,047.13 Typical High $1,258.93 | Professional | 50 · Both sides | $691.83 | $1,047.13 | $1,258.93 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $223.87 Median $239.88 Typical High $257.04 | Professional | 52 · Reduced service | $223.87 | $239.88 | $257.04 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $91.20 Median $97.72 Typical High $102.33 | Professional | 53 · Discontinued | $91.20 | $97.72 | $102.33 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $338.84 Median $363.08 Typical High $380.19 | Professional | 54 · Surgery only | $338.84 | $363.08 | $380.19 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $72.44 Typical High $75.86 | Professional | 55 · Aftercare only | $67.61 | $72.44 | $75.86 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $45.71 Median $48.98 Typical High $51.29 | Professional | 56 · Pre-op care only | $45.71 | $48.98 | $51.29 |
Where Pennsylvania sits
The same service costs 3.6 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 $5,175MT $1,450
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.