How much rates vary
Facilitymedian $891 · 10th to 90th $240 to $7,244Professionalmedian $5,012 · 10th to 90th $4,074 to $9,333
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 $831.76 Median $5,128.61 Typical High $8,511.38 | Facility | None | $831.76 | $5,128.61 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $4,677.35 Median $4,897.79 Typical High $5,128.61 | Professional | None | $4,677.35 | $4,897.79 | $5,128.61 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,235.94 Median $3,467.37 Typical High $3,548.13 | Professional | 78 · Unplanned return to OR | $3,235.94 | $3,467.37 | $3,548.13 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $28,183.83 Typical High $56,234.13 | Facility | None | $3,981.07 | $28,183.83 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $4,786.30 Median $7,585.78 Typical High $9,772.37 | Professional | None | $4,786.30 | $7,585.78 | $9,772.37 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,630.78 Median $5,754.40 Typical High $7,413.10 | Professional | 78 · Unplanned return to OR | $3,630.78 | $5,754.40 | $7,413.10 |
Emblem Health Setting Professional Modifier None Typical Low $7,079.46 Median $7,079.46 Typical High $7,943.28 | Professional | None | $7,079.46 | $7,079.46 | $7,943.28 |
Geisinger Setting Professional Modifier None Typical Low $3,388.44 Median $5,754.40 Typical High $8,912.51 | Professional | None | $3,388.44 | $5,754.40 | $8,912.51 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $5,128.61 Typical High $8,709.64 | Facility | None | $831.76 | $5,128.61 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $4,677.35 Median $4,897.79 Typical High $5,128.61 | Professional | None | $4,677.35 | $4,897.79 | $5,128.61 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,235.94 Median $3,467.37 Typical High $3,548.13 | Professional | 78 · Unplanned return to OR | $3,235.94 | $3,467.37 | $3,548.13 |
Oscar Health Setting Professional Modifier None Typical Low $19.95 Median $4,073.80 Typical High $7,943.28 | Professional | None | $19.95 | $4,073.80 | $7,943.28 |
UPMC Health Plan Setting Facility Modifier None Typical Low $3,715.35 Median $3,715.35 Typical High $4,677.35 | Facility | None | $3,715.35 | $3,715.35 | $4,677.35 |
UPMC Health Plan Setting Professional Modifier None Typical Low $3,715.35 Median $3,715.35 Typical High $4,677.35 | Professional | None | $3,715.35 | $3,715.35 | $4,677.35 |
United Setting Facility Modifier None Typical Low $199.53 Median $562.34 Typical High $4,265.80 | Facility | None | $199.53 | $562.34 | $4,265.80 |
United Setting Professional Modifier None Typical Low $3,890.45 Median $4,897.79 Typical High $9,772.37 | Professional | None | $3,890.45 | $4,897.79 | $9,772.37 |
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 $2,290.87 Median $2,454.71 Typical High $2,570.40 | Professional | 52 · Reduced service | $2,290.87 | $2,454.71 | $2,570.40 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $933.25 Median $1,000.00 Typical High $1,023.29 | Professional | 53 · Discontinued | $933.25 | $1,000.00 | $1,023.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3,467.37 Median $3,715.35 Typical High $3,801.89 | Professional | 54 · Surgery only | $3,467.37 | $3,715.35 | $3,801.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $691.83 Median $741.31 Typical High $758.58 | Professional | 55 · Aftercare only | $691.83 | $741.31 | $758.58 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $467.74 Median $501.19 Typical High $512.86 | Professional | 56 · Pre-op care only | $467.74 | $501.19 | $512.86 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2,290.87 Median $2,454.71 Typical High $2,570.40 | Professional | 52 · Reduced service | $2,290.87 | $2,454.71 | $2,570.40 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $933.25 Median $1,000.00 Typical High $1,023.29 | Professional | 53 · Discontinued | $933.25 | $1,000.00 | $1,023.29 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $3,467.37 Median $3,715.35 Typical High $3,801.89 | Professional | 54 · Surgery only | $3,467.37 | $3,715.35 | $3,801.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $691.83 Median $741.31 Typical High $758.58 | Professional | 55 · Aftercare only | $691.83 | $741.31 | $758.58 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $467.74 Median $501.19 Typical High $512.86 | Professional | 56 · Pre-op care only | $467.74 | $501.19 | $512.86 |
Where Pennsylvania sits
The same service costs 8.4 times more in Wisconsin 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.
Physician feeFacility fee
WI $28,671TX $3,407
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.