How much rates vary
Facilitymedian $589 · 10th to 90th $178 to $4,365Professionalmedian $191 · 10th to 90th $117 to $302
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 $234.42 Median $2,137.96 Typical High $8,317.64 | Facility | None | $234.42 | $2,137.96 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $199.53 Typical High $251.19 | Professional | None | $120.23 | $199.53 | $251.19 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $123.03 Typical High $162.18 | Professional | 78 · Unplanned return to OR | $79.43 | $123.03 | $162.18 |
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 $194.98 Median $194.98 Typical High $56,234.13 | Professional | None | $194.98 | $194.98 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $269.15 Typical High $323.59 | Professional | 78 · Unplanned return to OR | $165.96 | $269.15 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $177.83 Median $426.58 Typical High $851.14 | Facility | None | $177.83 | $426.58 | $851.14 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $190.55 Typical High $354.81 | Professional | None | $117.49 | $190.55 | $354.81 |
Emblem Health Setting Professional Modifier None Typical Low $354.81 Median $354.81 Typical High $371.54 | Professional | None | $354.81 | $354.81 | $371.54 |
Geisinger Setting Facility Modifier None Typical Low $162.18 Median $204.17 Typical High $354.81 | Facility | None | $162.18 | $204.17 | $354.81 |
Geisinger Setting Professional Modifier None Typical Low $123.03 Median $223.87 Typical High $354.81 | Professional | None | $123.03 | $223.87 | $354.81 |
Highmark BCBS Setting Facility Modifier None Typical Low $602.56 Median $6,918.31 Typical High $22,908.68 | Facility | None | $602.56 | $6,918.31 | $22,908.68 |
Martin's Point Setting Facility Modifier None Typical Low $426.58 Median $2,137.96 Typical High $7,244.36 | Facility | None | $426.58 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $117.49 Median $199.53 Typical High $263.03 | Professional | None | $117.49 | $199.53 | $263.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $123.03 Typical High $162.18 | Professional | 78 · Unplanned return to OR | $79.43 | $123.03 | $162.18 |
Oscar Health Setting Professional Modifier None Typical Low $165.96 Median $177.83 Typical High $398.11 | Professional | None | $165.96 | $177.83 | $398.11 |
UPMC Health Plan Setting Facility Modifier None Typical Low $138.04 Median $302.00 Typical High $691.83 | Facility | None | $138.04 | $302.00 | $691.83 |
UPMC Health Plan Setting Professional Modifier None Typical Low $120.23 Median $190.55 Typical High $208.93 | Professional | None | $120.23 | $190.55 | $208.93 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $4,265.80 | Facility | None | $416.87 | $724.44 | $4,265.80 |
United Setting Professional Modifier None Typical Low $112.20 Median $194.98 Typical High $331.13 | Professional | None | $112.20 | $194.98 | $331.13 |
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 $87.10 Typical High $117.49 | Professional | 52 · Reduced service | $57.54 | $87.10 | $117.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $34.67 Typical High $46.77 | Professional | 53 · Discontinued | $22.91 | $34.67 | $46.77 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $131.83 Typical High $173.78 | Professional | 54 · Surgery only | $85.11 | $131.83 | $173.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $26.30 Typical High $35.48 | Professional | 55 · Aftercare only | $16.98 | $26.30 | $35.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $17.38 Typical High $23.44 | Professional | 56 · Pre-op care only | $11.48 | $17.38 | $23.44 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $56.23 Median $87.10 Typical High $117.49 | Professional | 52 · Reduced service | $56.23 | $87.10 | $117.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $22.39 Median $34.67 Typical High $46.77 | Professional | 53 · Discontinued | $22.39 | $34.67 | $46.77 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $85.11 Median $131.83 Typical High $173.78 | Professional | 54 · Surgery only | $85.11 | $131.83 | $173.78 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $16.98 Median $26.30 Typical High $35.48 | Professional | 55 · Aftercare only | $16.98 | $26.30 | $35.48 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $11.22 Median $17.38 Typical High $23.44 | Professional | 56 · Pre-op care only | $11.22 | $17.38 | $23.44 |
Where Pennsylvania sits
The same service costs 3.8 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· 45th of 51
$204
WI $631KY $166
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.