How much rates vary
Facilitymedian $186 · 10th to 90th $78 to $2,570Professionalmedian $219 · 10th to 90th $145 to $355
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 $199.53 Median $1,584.89 Typical High $8,511.38 | Facility | None | $199.53 | $1,584.89 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $144.54 Median $218.78 Typical High $275.42 | Professional | None | $144.54 | $218.78 | $275.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $95.50 Median $144.54 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $95.50 | $144.54 | $177.83 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,511.89 Median $2,570.40 Typical High $56,234.13 | Facility | None | $2,511.89 | $2,570.40 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $331.13 | Professional | None | $229.09 | $229.09 | $331.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $173.78 Median $288.40 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $173.78 | $288.40 | $416.87 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $144.54 Typical High $275.42 | Facility | None | $50.12 | $144.54 | $275.42 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $218.78 Typical High $363.08 | Professional | None | $147.91 | $218.78 | $363.08 |
Emblem Health Setting Professional Modifier None Typical Low $380.19 Median $380.19 Typical High $398.11 | Professional | None | $380.19 | $380.19 | $398.11 |
Geisinger Setting Facility Modifier None Typical Low $125.89 Median $158.49 Typical High $275.42 | Facility | None | $125.89 | $158.49 | $275.42 |
Geisinger Setting Professional Modifier None Typical Low $158.49 Median $257.04 Typical High $389.05 | Professional | None | $158.49 | $257.04 | $389.05 |
Martin's Point Setting Facility Modifier None Typical Low $251.19 Median $1,584.89 Typical High $8,511.38 | Facility | None | $251.19 | $1,584.89 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $141.25 Median $218.78 Typical High $257.04 | Professional | None | $141.25 | $218.78 | $257.04 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $95.50 Median $144.54 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $95.50 | $144.54 | $177.83 |
Oscar Health Setting Professional Modifier None Typical Low $173.78 Median $186.21 Typical High $478.63 | Professional | None | $173.78 | $186.21 | $478.63 |
UPMC Health Plan Setting Facility Modifier None Typical Low $151.36 Median $218.78 Typical High $436.52 | Facility | None | $151.36 | $218.78 | $436.52 |
UPMC Health Plan Setting Professional Modifier None Typical Low $141.25 Median $204.17 Typical High $218.78 | Professional | None | $141.25 | $204.17 | $218.78 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,230.27 | Facility | None | $77.62 | $158.49 | $1,230.27 |
United Setting Professional Modifier None Typical Low $147.91 Median $245.47 Typical High $446.68 | Professional | None | $147.91 | $245.47 | $446.68 |
11 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 $69.18 Median $104.71 Typical High $125.89 | Professional | 52 · Reduced service | $69.18 | $104.71 | $125.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $27.54 Median $41.69 Typical High $51.29 | Professional | 53 · Discontinued | $27.54 | $41.69 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $154.88 Typical High $190.55 | Professional | 54 · Surgery only | $102.33 | $154.88 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $30.90 Typical High $38.02 | Professional | 55 · Aftercare only | $20.42 | $30.90 | $38.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $20.89 Typical High $25.12 | Professional | 56 · Pre-op care only | $13.80 | $20.89 | $25.12 |
Highmark BCBS Setting Facility Modifier 59 · Distinct service Typical Low $389.05 Median $389.05 Typical High $389.05 | Facility | 59 · Distinct service | $389.05 | $389.05 | $389.05 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $69.18 Median $104.71 Typical High $125.89 | Professional | 52 · Reduced service | $69.18 | $104.71 | $125.89 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $27.54 Median $41.69 Typical High $51.29 | Professional | 53 · Discontinued | $27.54 | $41.69 | $51.29 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $154.88 Typical High $190.55 | Professional | 54 · Surgery only | $102.33 | $154.88 | $190.55 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $30.90 Typical High $38.02 | Professional | 55 · Aftercare only | $20.42 | $30.90 | $38.02 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $20.89 Typical High $25.12 | Professional | 56 · Pre-op care only | $13.80 | $20.89 | $25.12 |
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· 43rd of 51
$219
WI $708TX $191
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.