How much rates vary
Facilitymedian $437 · 10th to 90th $100 to $3,020Professionalmedian $288 · 10th to 90th $195 to $479
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 $331.13 Median $1,995.26 Typical High $7,943.28 | Facility | None | $331.13 | $1,995.26 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $199.53 Median $288.40 Typical High $338.84 | Professional | None | $199.53 | $288.40 | $338.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $190.55 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $134.90 | $190.55 | $234.42 |
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 $416.87 Median $467.74 Typical High $524.81 | Professional | None | $416.87 | $467.74 | $524.81 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $234.42 Median $380.19 Typical High $524.81 | Professional | 78 · Unplanned return to OR | $234.42 | $380.19 | $524.81 |
Cigna Setting Facility Modifier None Typical Low $302.00 Median $426.58 Typical High $645.65 | Facility | None | $302.00 | $426.58 | $645.65 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $288.40 Typical High $478.63 | Professional | None | $208.93 | $288.40 | $478.63 |
Emblem Health Setting Professional Modifier None Typical Low $512.86 Median $512.86 Typical High $537.03 | Professional | None | $512.86 | $512.86 | $537.03 |
Geisinger Setting Facility Modifier None Typical Low $288.40 Median $354.81 Typical High $630.96 | Facility | None | $288.40 | $354.81 | $630.96 |
Geisinger Setting Professional Modifier None Typical Low $223.87 Median $346.74 Typical High $549.54 | Professional | None | $223.87 | $346.74 | $549.54 |
Highmark BCBS Setting Facility Modifier None Typical Low $794.33 Median $1,659.59 Typical High $2,454.71 | Facility | None | $794.33 | $1,659.59 | $2,454.71 |
Martin's Point Setting Facility Modifier None Typical Low $331.13 Median $1,995.26 Typical High $6,606.93 | Facility | None | $331.13 | $1,995.26 | $6,606.93 |
Martin's Point Setting Professional Modifier None Typical Low $194.98 Median $288.40 Typical High $338.84 | Professional | None | $194.98 | $288.40 | $338.84 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $190.55 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $134.90 | $190.55 | $234.42 |
Oscar Health Setting Professional Modifier None Typical Low $234.42 Median $257.04 Typical High $630.96 | Professional | None | $234.42 | $257.04 | $630.96 |
UPMC Health Plan Setting Facility Modifier None Typical Low $190.55 Median $812.83 Typical High $1,862.09 | Facility | None | $190.55 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $190.55 Median $263.03 Typical High $288.40 | Professional | None | $190.55 | $263.03 | $288.40 |
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 $204.17 Median $323.59 Typical High $562.34 | Professional | None | $204.17 | $323.59 | $562.34 |
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 $95.50 Median $138.04 Typical High $165.96 | Professional | 52 · Reduced service | $95.50 | $138.04 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $54.95 Typical High $67.61 | Professional | 53 · Discontinued | $38.90 | $54.95 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $204.17 Typical High $251.19 | Professional | 54 · Surgery only | $144.54 | $204.17 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $40.74 Typical High $50.12 | Professional | 55 · Aftercare only | $28.84 | $40.74 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $27.54 Typical High $33.11 | Professional | 56 · Pre-op care only | $19.05 | $27.54 | $33.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $95.50 Median $138.04 Typical High $165.96 | Professional | 52 · Reduced service | $95.50 | $138.04 | $165.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $54.95 Typical High $67.61 | Professional | 53 · Discontinued | $38.90 | $54.95 | $67.61 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $204.17 Typical High $251.19 | Professional | 54 · Surgery only | $144.54 | $204.17 | $251.19 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $40.74 Typical High $50.12 | Professional | 55 · Aftercare only | $28.84 | $40.74 | $50.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $27.54 Typical High $33.11 | Professional | 56 · Pre-op care only | $19.05 | $27.54 | $33.11 |
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
$309
WI $933TX $251
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.