How much rates vary
Facilitymedian $1,698 · 10th to 90th $603 to $5,495Professionalmedian $437 · 10th to 90th $347 to $741
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 $660.69 Median $3,801.89 Typical High $8,317.64 | Facility | None | $660.69 | $3,801.89 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $389.05 Median $426.58 Typical High $436.52 | Professional | None | $389.05 | $426.58 | $436.52 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $269.15 Median $302.00 Typical High $309.03 | Professional | 78 · Unplanned return to OR | $269.15 | $302.00 | $309.03 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $8,709.64 | Facility | None | $3,981.07 | $7,413.10 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $588.84 Median $660.69 Typical High $741.31 | Professional | None | $588.84 | $660.69 | $741.31 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $338.84 Median $537.03 Typical High $676.08 | Professional | 78 · Unplanned return to OR | $338.84 | $537.03 | $676.08 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,380.38 Typical High $2,344.23 | Facility | None | $501.19 | $1,380.38 | $2,344.23 |
Cigna Setting Professional Modifier None Typical Low $346.74 Median $398.11 Typical High $831.76 | Professional | None | $346.74 | $398.11 | $831.76 |
Emblem Health Setting Professional Modifier None Typical Low $478.63 Median $676.08 Typical High $912.01 | Professional | None | $478.63 | $676.08 | $912.01 |
Geisinger Setting Facility Modifier None Typical Low $1,380.38 Median $1,737.80 Typical High $3,019.95 | Facility | None | $1,380.38 | $1,737.80 | $3,019.95 |
Geisinger Setting Professional Modifier None Typical Low $338.84 Median $436.52 Typical High $741.31 | Professional | None | $338.84 | $436.52 | $741.31 |
Highmark BCBS Setting Facility Modifier None Typical Low $5,888.44 Median $7,762.47 Typical High $15,135.61 | Facility | None | $5,888.44 | $7,762.47 | $15,135.61 |
Highmark BCBS Setting Professional Modifier None Typical Low $478.63 Median $478.63 Typical High $478.63 | Professional | None | $478.63 | $478.63 | $478.63 |
Martin's Point Setting Facility Modifier None Typical Low $724.44 Median $3,715.35 Typical High $8,317.64 | Facility | None | $724.44 | $3,715.35 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $389.05 Median $426.58 Typical High $436.52 | Professional | None | $389.05 | $426.58 | $436.52 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $269.15 Median $302.00 Typical High $309.03 | Professional | 78 · Unplanned return to OR | $269.15 | $302.00 | $309.03 |
Oscar Health Setting Professional Modifier None Typical Low $478.63 Median $501.19 Typical High $758.58 | Professional | None | $478.63 | $501.19 | $758.58 |
UPMC Health Plan Setting Facility Modifier None Typical Low $407.38 Median $1,737.80 Typical High $3,388.44 | Facility | None | $407.38 | $1,737.80 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $407.38 Median $416.87 Typical High $467.74 | Professional | None | $407.38 | $416.87 | $467.74 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,265.80 | Facility | None | $812.83 | $1,318.26 | $4,265.80 |
United Setting Professional Modifier None Typical Low $363.08 Median $436.52 Typical High $676.08 | Professional | None | $363.08 | $436.52 | $676.08 |
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 $194.98 Median $213.80 Typical High $218.78 | Professional | 52 · Reduced service | $194.98 | $213.80 | $218.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $77.62 Median $85.11 Typical High $89.13 | Professional | 53 · Discontinued | $77.62 | $85.11 | $89.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $288.40 Median $323.59 Typical High $331.13 | Professional | 54 · Surgery only | $288.40 | $323.59 | $331.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $58.88 Median $64.57 Typical High $66.07 | Professional | 55 · Aftercare only | $58.88 | $64.57 | $66.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $38.90 Median $42.66 Typical High $43.65 | Professional | 56 · Pre-op care only | $38.90 | $42.66 | $43.65 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $194.98 Median $213.80 Typical High $218.78 | Professional | 52 · Reduced service | $194.98 | $213.80 | $218.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $77.62 Median $85.11 Typical High $89.13 | Professional | 53 · Discontinued | $77.62 | $85.11 | $89.13 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $288.40 Median $323.59 Typical High $331.13 | Professional | 54 · Surgery only | $288.40 | $323.59 | $331.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $58.88 Median $64.57 Typical High $66.07 | Professional | 55 · Aftercare only | $58.88 | $64.57 | $66.07 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $38.90 Median $42.66 Typical High $43.65 | Professional | 56 · Pre-op care only | $38.90 | $42.66 | $43.65 |
Where Pennsylvania sits
The same service costs 4.4 times more in Oklahoma than in Montana. 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.
Physician feeFacility fee
OK $6,113MT $1,385
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.