How much rates vary
Facilitymedian $1,778 · 10th to 90th $692 to $6,457Professionalmedian $245 · 10th to 90th $224 to $407
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 $588.84 Median $4,786.30 Typical High $8,511.38 | Facility | None | $588.84 | $4,786.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $223.87 Median $257.04 Typical High $275.42 | Professional | None | $223.87 | $257.04 | $275.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $158.49 Median $173.78 Typical High $181.97 | Professional | 78 · Unplanned return to OR | $158.49 | $173.78 | $181.97 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $56,234.13 | Facility | None | $3,981.07 | $7,413.10 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $245.47 Median $245.47 Typical High $446.68 | Professional | None | $245.47 | $245.47 | $446.68 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $199.53 Median $316.23 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $199.53 | $316.23 | $389.05 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,445.44 Typical High $2,818.38 | Facility | None | $616.60 | $1,445.44 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $229.09 Median $239.88 Typical High $457.09 | Professional | None | $229.09 | $239.88 | $457.09 |
Emblem Health Setting Professional Modifier None Typical Low $263.03 Median $354.81 Typical High $489.78 | Professional | None | $263.03 | $354.81 | $489.78 |
Geisinger Setting Facility Modifier None Typical Low $1,445.44 Median $1,778.28 Typical High $3,162.28 | Facility | None | $1,445.44 | $1,778.28 | $3,162.28 |
Geisinger Setting Professional Modifier None Typical Low $223.87 Median $263.03 Typical High $426.58 | Professional | None | $223.87 | $263.03 | $426.58 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,318.26 Median $2,818.38 Typical High $10,964.78 | Facility | None | $1,318.26 | $2,818.38 | $10,964.78 |
Martin's Point Setting Facility Modifier None Typical Low $724.44 Median $4,570.88 Typical High $8,511.38 | Facility | None | $724.44 | $4,570.88 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $223.87 Median $251.19 Typical High $257.04 | Professional | None | $223.87 | $251.19 | $257.04 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $158.49 Median $173.78 Typical High $181.97 | Professional | 78 · Unplanned return to OR | $158.49 | $173.78 | $181.97 |
Oscar Health Setting Professional Modifier None Typical Low $302.00 Median $323.59 Typical High $478.63 | Professional | None | $302.00 | $323.59 | $478.63 |
UPMC Health Plan Setting Facility Modifier None Typical Low $239.88 Median $2,137.96 Typical High $4,265.80 | Facility | None | $239.88 | $2,137.96 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $239.88 Median $245.47 Typical High $323.59 | Professional | None | $239.88 | $245.47 | $323.59 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,570.88 | Facility | None | $812.83 | $1,318.26 | $4,570.88 |
United Setting Professional Modifier None Typical Low $208.93 Median $239.88 Typical High $389.05 | Professional | None | $208.93 | $239.88 | $389.05 |
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 $112.20 Median $125.89 Typical High $128.82 | Professional | 52 · Reduced service | $112.20 | $125.89 | $128.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $50.12 Typical High $51.29 | Professional | 53 · Discontinued | $45.71 | $50.12 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $169.82 Median $186.21 Typical High $194.98 | Professional | 54 · Surgery only | $169.82 | $186.21 | $194.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $37.15 Typical High $38.90 | Professional | 55 · Aftercare only | $33.88 | $37.15 | $38.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.39 Median $25.12 Typical High $25.70 | Professional | 56 · Pre-op care only | $22.39 | $25.12 | $25.70 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $112.20 Median $125.89 Typical High $128.82 | Professional | 52 · Reduced service | $112.20 | $125.89 | $128.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $50.12 Typical High $51.29 | Professional | 53 · Discontinued | $45.71 | $50.12 | $51.29 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $169.82 Median $186.21 Typical High $194.98 | Professional | 54 · Surgery only | $169.82 | $186.21 | $194.98 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $37.15 Typical High $38.90 | Professional | 55 · Aftercare only | $33.88 | $37.15 | $38.90 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $22.39 Median $25.12 Typical High $25.70 | Professional | 56 · Pre-op care only | $22.39 | $25.12 | $25.70 |
Where Pennsylvania sits
The same service costs 6.0 times more in Alaska than in Utah. 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
$245
AK $1,000UT $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.