How much rates vary
Facilitymedian $562 · 10th to 90th $209 to $4,365Professionalmedian $245 · 10th to 90th $155 to $363
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 $281.84 Median $2,344.23 Typical High $8,317.64 | Facility | None | $281.84 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $165.96 Median $245.47 Typical High $302.00 | Professional | None | $165.96 | $245.47 | $302.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $109.65 Median $162.18 Typical High $199.53 | Professional | 78 · Unplanned return to OR | $109.65 | $162.18 | $199.53 |
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 $257.04 Median $257.04 Typical High $257.04 | Professional | None | $257.04 | $257.04 | $257.04 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $194.98 Median $323.59 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $194.98 | $323.59 | $416.87 |
Cigna Setting Facility Modifier None Typical Low $218.78 Median $331.13 Typical High $562.34 | Facility | None | $218.78 | $331.13 | $562.34 |
Cigna Setting Professional Modifier None Typical Low $154.88 Median $234.42 Typical High $416.87 | Professional | None | $154.88 | $234.42 | $416.87 |
Emblem Health Setting Professional Modifier None Typical Low $416.87 Median $416.87 Typical High $426.58 | Professional | None | $416.87 | $416.87 | $426.58 |
Geisinger Setting Facility Modifier None Typical Low $199.53 Median $245.47 Typical High $436.52 | Facility | None | $199.53 | $245.47 | $436.52 |
Geisinger Setting Professional Modifier None Typical Low $154.88 Median $263.03 Typical High $416.87 | Professional | None | $154.88 | $263.03 | $416.87 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,548.13 Median $3,548.13 Typical High $3,548.13 | Facility | None | $3,548.13 | $3,548.13 | $3,548.13 |
Martin's Point Setting Facility Modifier None Typical Low $478.63 Median $2,137.96 Typical High $7,244.36 | Facility | None | $478.63 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $165.96 Median $245.47 Typical High $309.03 | Professional | None | $165.96 | $245.47 | $309.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $109.65 Median $162.18 Typical High $199.53 | Professional | 78 · Unplanned return to OR | $109.65 | $162.18 | $199.53 |
Oscar Health Setting Professional Modifier None Typical Low $144.54 Median $154.88 Typical High $524.81 | Professional | None | $144.54 | $154.88 | $524.81 |
UPMC Health Plan Setting Facility Modifier None Typical Low $128.82 Median $812.83 Typical High $1,862.09 | Facility | None | $128.82 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $128.82 Median $190.55 Typical High $251.19 | Professional | None | $128.82 | $190.55 | $251.19 |
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 $147.91 Median $245.47 Typical High $407.38 | Professional | None | $147.91 | $245.47 | $407.38 |
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 $77.62 Median $117.49 Typical High $141.25 | Professional | 52 · Reduced service | $77.62 | $117.49 | $141.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.90 Median $46.77 Typical High $57.54 | Professional | 53 · Discontinued | $30.90 | $46.77 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $117.49 Median $173.78 Typical High $213.80 | Professional | 54 · Surgery only | $117.49 | $173.78 | $213.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.44 Median $34.67 Typical High $42.66 | Professional | 55 · Aftercare only | $23.44 | $34.67 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.49 Median $23.44 Typical High $28.18 | Professional | 56 · Pre-op care only | $15.49 | $23.44 | $28.18 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $77.62 Median $117.49 Typical High $141.25 | Professional | 52 · Reduced service | $77.62 | $117.49 | $141.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $30.90 Median $46.77 Typical High $57.54 | Professional | 53 · Discontinued | $30.90 | $46.77 | $57.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $117.49 Median $173.78 Typical High $213.80 | Professional | 54 · Surgery only | $117.49 | $173.78 | $213.80 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $23.44 Median $34.67 Typical High $42.66 | Professional | 55 · Aftercare only | $23.44 | $34.67 | $42.66 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $15.49 Median $23.44 Typical High $28.18 | Professional | 56 · Pre-op care only | $15.49 | $23.44 | $28.18 |
Where Pennsylvania sits
The same service costs 4.3 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· 42nd of 51
$257
WI $794KY $186
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.