How much rates vary
Facilitymedian $5,888 · 10th to 90th $617 to $13,804Professionalmedian $407 · 10th to 90th $324 to $692
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 $676.08 Median $3,890.45 Typical High $8,317.64 | Facility | None | $676.08 | $3,890.45 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $363.08 Median $407.38 Typical High $489.78 | Professional | None | $363.08 | $407.38 | $489.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $251.19 Median $281.84 Typical High $288.40 | Professional | 78 · Unplanned return to OR | $251.19 | $281.84 | $288.40 |
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 $331.13 Median $562.34 Typical High $724.44 | Professional | None | $331.13 | $562.34 | $724.44 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $478.63 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $281.84 | $478.63 | $616.60 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $6,165.95 Typical High $12,302.69 | Facility | None | $501.19 | $6,165.95 | $12,302.69 |
Cigna Setting Professional Modifier None Typical Low $323.59 Median $398.11 Typical High $676.08 | Professional | None | $323.59 | $398.11 | $676.08 |
Emblem Health Setting Professional Modifier None Typical Low $478.63 Median $478.63 Typical High $524.81 | Professional | None | $478.63 | $478.63 | $524.81 |
Geisinger Setting Facility Modifier None Typical Low $6,309.57 Median $7,762.47 Typical High $13,803.84 | Facility | None | $6,309.57 | $7,762.47 | $13,803.84 |
Geisinger Setting Professional Modifier None Typical Low $338.84 Median $446.68 Typical High $707.95 | Professional | None | $338.84 | $446.68 | $707.95 |
Highmark BCBS Setting Facility Modifier None Typical Low $17,782.79 Median $17,782.79 Typical High $28,840.32 | Facility | None | $17,782.79 | $17,782.79 | $28,840.32 |
Martin's Point Setting Facility Modifier None Typical Low $758.58 Median $3,715.35 Typical High $8,317.64 | Facility | None | $758.58 | $3,715.35 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $363.08 Median $407.38 Typical High $489.78 | Professional | None | $363.08 | $407.38 | $489.78 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $251.19 Median $281.84 Typical High $288.40 | Professional | 78 · Unplanned return to OR | $251.19 | $281.84 | $288.40 |
Oscar Health Setting Professional Modifier None Typical Low $363.08 Median $363.08 Typical High $371.54 | Professional | None | $363.08 | $363.08 | $371.54 |
UPMC Health Plan Setting Facility Modifier None Typical Low $316.23 Median $316.23 Typical High $331.13 | Facility | None | $316.23 | $316.23 | $331.13 |
UPMC Health Plan Setting Professional Modifier None Typical Low $316.23 Median $316.23 Typical High $331.13 | Professional | None | $316.23 | $316.23 | $331.13 |
United Setting Facility Modifier None Typical Low $2,818.38 Median $5,754.40 Typical High $17,782.79 | Facility | None | $2,818.38 | $5,754.40 | $17,782.79 |
United Setting Professional Modifier None Typical Low $316.23 Median $436.52 Typical High $707.95 | Professional | None | $316.23 | $436.52 | $707.95 |
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 $181.97 Median $199.53 Typical High $204.17 | Professional | 52 · Reduced service | $181.97 | $199.53 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $72.44 Median $81.28 Typical High $81.28 | Professional | 53 · Discontinued | $72.44 | $81.28 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $269.15 Median $302.00 Typical High $309.03 | Professional | 54 · Surgery only | $269.15 | $302.00 | $309.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $54.95 Median $60.26 Typical High $61.66 | Professional | 55 · Aftercare only | $54.95 | $60.26 | $61.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $36.31 Median $40.74 Typical High $40.74 | Professional | 56 · Pre-op care only | $36.31 | $40.74 | $40.74 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $181.97 Median $199.53 Typical High $204.17 | Professional | 52 · Reduced service | $181.97 | $199.53 | $204.17 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $72.44 Median $81.28 Typical High $81.28 | Professional | 53 · Discontinued | $72.44 | $81.28 | $81.28 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $269.15 Median $302.00 Typical High $309.03 | Professional | 54 · Surgery only | $269.15 | $302.00 | $309.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $54.95 Median $60.26 Typical High $61.66 | Professional | 55 · Aftercare only | $54.95 | $60.26 | $61.66 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $36.31 Median $40.74 Typical High $40.74 | Professional | 56 · Pre-op care only | $36.31 | $40.74 | $40.74 |
Where Pennsylvania sits
The same service costs 21.5 times more in Oklahoma 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
OK $21,837MT $1,015
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.