How much rates vary
Facilitymedian $427 · 10th to 90th $100 to $3,802Professionalmedian $275 · 10th to 90th $191 to $427
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 $302.00 Median $3,090.30 Typical High $8,511.38 | Facility | None | $302.00 | $3,090.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $190.55 Median $263.03 Typical High $302.00 | Professional | None | $190.55 | $263.03 | $302.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $131.83 Median $186.21 Typical High $213.80 | Professional | 78 · Unplanned return to OR | $131.83 | $186.21 | $213.80 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,630.27 Median $3,019.95 Typical High $56,234.13 | Facility | None | $2,630.27 | $3,019.95 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $56,234.13 | Professional | None | $309.03 | $309.03 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $223.87 Median $363.08 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $223.87 | $363.08 | $575.44 |
Cigna Setting Facility Modifier None Typical Low $204.17 Median $426.58 Typical High $794.33 | Facility | None | $204.17 | $426.58 | $794.33 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $295.12 Typical High $457.09 | Professional | None | $204.17 | $295.12 | $457.09 |
Emblem Health Setting Professional Modifier None Typical Low $478.63 Median $478.63 Typical High $489.78 | Professional | None | $478.63 | $478.63 | $489.78 |
Geisinger Setting Facility Modifier None Typical Low $186.21 Median $234.42 Typical High $407.38 | Facility | None | $186.21 | $234.42 | $407.38 |
Geisinger Setting Professional Modifier None Typical Low $223.87 Median $331.13 Typical High $549.54 | Professional | None | $223.87 | $331.13 | $549.54 |
Martin's Point Setting Facility Modifier None Typical Low $575.44 Median $2,691.53 Typical High $8,317.64 | Facility | None | $575.44 | $2,691.53 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $181.97 Median $263.03 Typical High $302.00 | Professional | None | $181.97 | $263.03 | $302.00 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $128.82 Median $186.21 Typical High $213.80 | Professional | 78 · Unplanned return to OR | $128.82 | $186.21 | $213.80 |
Oscar Health Setting Professional Modifier None Typical Low $257.04 Median $295.12 Typical High $630.96 | Professional | None | $257.04 | $295.12 | $630.96 |
UPMC Health Plan Setting Facility Modifier None Typical Low $245.47 Median $1,096.48 Typical High $2,511.89 | Facility | None | $245.47 | $1,096.48 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $190.55 Median $269.15 Typical High $346.74 | Professional | None | $190.55 | $269.15 | $346.74 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,698.24 | Facility | None | $77.62 | $158.49 | $1,698.24 |
United Setting Professional Modifier None Typical Low $190.55 Median $295.12 Typical High $489.78 | Professional | None | $190.55 | $295.12 | $489.78 |
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 $93.33 Median $131.83 Typical High $151.36 | Professional | 52 · Reduced service | $93.33 | $131.83 | $151.36 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $52.48 Typical High $60.26 | Professional | 53 · Discontinued | $37.15 | $52.48 | $60.26 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $199.53 Typical High $229.09 | Professional | 54 · Surgery only | $141.25 | $199.53 | $229.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $39.81 Typical High $45.71 | Professional | 55 · Aftercare only | $28.18 | $39.81 | $45.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $26.30 Typical High $30.20 | Professional | 56 · Pre-op care only | $18.62 | $26.30 | $30.20 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $91.20 Median $131.83 Typical High $151.36 | Professional | 52 · Reduced service | $91.20 | $131.83 | $151.36 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $36.31 Median $52.48 Typical High $60.26 | Professional | 53 · Discontinued | $36.31 | $52.48 | $60.26 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $199.53 Typical High $229.09 | Professional | 54 · Surgery only | $138.04 | $199.53 | $229.09 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $39.81 Typical High $45.71 | Professional | 55 · Aftercare only | $27.54 | $39.81 | $45.71 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $18.20 Median $26.30 Typical High $30.20 | Professional | 56 · Pre-op care only | $18.20 | $26.30 | $30.20 |
Where Pennsylvania sits
The same service costs 3.7 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.
Pennsylvania· 44th of 51
$282
WI $891TX $240
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.